Removal of intrahepatic bile duct stones

To keep this study homogeneous, we have limited ourselves to intrahepatic lithiases of the bile ducts above the hilus, usually linked with extrahepatic lithiases. While operating, all technical resources must be utilized in order to remove as many stones as possible. To gain access to the hepatic duct, it is sometimes necessary to excise the hilar plane; scissurotomy is the most efficient way to free the intrahepatic ducts when they are full of stones. In rare cases of localized lithiases, one may perform hepatic resection. We have perfected a technic using a special malleable catheter, guided by television, combined with suction of the stones for intrahepatic blocked stones. Forty-four interventions are presented. We have grouped them according to whether they involved an accumulation of stones from the extrahepatic ducts or stones blocked in a bile duct. There were three cases of dispersed intrahepatic lithiasis and one peripheral localization. Following extraction of the stones, we ended the intervention by 19 Kehr drainages, seven choledochotomies, five sphincterotomies, 11 biliodigestive anastomoses, one hepatectomy and one hepatotomy. We deliberately left some stones undisturbed in seven cases: the results even after some years remain satisfactory except for one case of dispersed lithiasis.