Electrohydraulic lithotripsy combined with laparoscopy and endoscopy for managing difficult biliary stones

Large or impacted bile duct stones can be difficult to manage with endoscopic and laparoscopic techniques. Electrohydraulic lithotripsy (EHL) seems to be ideally suited for these difficult cases. We report our experience and review the literature. Adjunctive use of EHL was attempted in seven patients with complicated stones. In six, preoperative endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful. Five were accessed with laparoscopic transcystic technique, one by T-tube tract, and one with open common bile duct (CBD) exploration. EHL was successful in six. The unsuccessful attempt was with a 5-cm CBD stone. No complications of EHL were encountered. In review of the literature, we have found 256 cases of biliary lithiasis successfully treated with EHL without bile duct perforation. Based on our own experience and review of the literature, we conclude that properly used EHL is safe and effective in managing complicated biliary lithiasis.