Treatment of intrahepatic lithiasis using the choledochofiberscope

Our experience with choledochoscopic extraction of intrahepatic calculi in eleven cases is presented. In three cases, the intrahepatic bile duct containing multiple stones was punctured under the guidance of ultrasonography, and the stones were removed choledochoscopically through the percutaneous transhepatic cholangial drainage (PTCD) tract which was dilated with catheters of increasing diameter. In nine cases, the removal of intrahepatic stones was attempted choledochoscopically through the T-tube tract or the jejunostomy. This procedure was successful in six of the nine cases. The advantage of the choledochoscopic removal through the PTCD tract compared with that through the T-tube tract is discussed, and an illustrative case is presented.