Laser lithotripsy for the management of retained stones

The morbidity of reoperation for retained biliary stones is not significant. Many techniques have been developed to avoid reoperation. This study analyzes T-tube tract choledochoscopy and lithotripsy using a 504-nm pulsed dye laser for treatment of retained stones. A flexible choledochoscope is passed into the biliary tract and laser energy is delivered under endoscopic visualization after passing a 320-microns laser fiber through the instrument channel. Eight patients were treated in nine sessions. The mean number of pulses was 1512.33, delivered at 3 to 5 Hz with an energy of 100 to 120 mJ. In all patients, the biliary tract was cleared. A single patient's treatment was complicated by transient bacteremia. Mean follow-up was 10 months. Choledochoscopic laser lithotripsy is a safe, effective technique that may also play a major role in laparoscopic common duct surgery.