Treatment of Difficult Intrahepatic Stones by Using Extracorporeal and Intracorporeal Lithotripsy Techniques: 10 Years' Experience in 55 Patients

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Abstract
Intrahepatic lithiasis still is a complicated disease and merits special attention during therapeutic intervention. Although resection of the affected liver lobe or segment is the best therapeutic option to completely remove the source of recurrent infection, the need for endoscopic treatment modalities is evident because hepatic resections are combined with a high morbidity and mortality rate. Over a 10-year period (1988-1997) 55 patients with intrahepatic stones that were not accessible to routine endoscopic extraction were treated at our department. These patients underwent either extracorporeal shock-wave lithotripsy (n=27) or intracorporeal electrohydraulic (n=12) or laser lithotripsy (n=16). Using these techniques, we achieved stone fragmentation in 33.3%, 41.6%, and 75%, respectively. With a combination of the different methods, more than 90% of intrahepatic stones could be removed endoscopically. Overall complication rate was 12.7%; complete recovery was achieved in all patients with conservative management. The endoscopic approach to intrahepatic lithiasis appears to be a useful alternative to surgery, with a lower morbidity and mortality. If endoscopic therapy fails, surgery is still possible.