Choledochofiberoscopy in the postoperative management of intrahepatic stones

We prefer a nonaggressive approach to the treatment of high risk patients with intrahepatic stones. We perform extensive choledochotomy, remove all accessible intrahepatic stones, use bouginage of all stenotic segments and maintain patency with a T-tube stent. Postoperatively, we extract the remaining intrahepatic stones mainly with the choledochofiberscope and various types of forceps. The combined use of the Burhenne catheter and Dormia basket and the different types of curved forceps, scoops and Bakes' dilator has improved the success rate of removal. Thirty patients have thus far been treated in this manner with encouraging results.