1933 percutaneous endoscopic laser lithotripsy in orthotopic liver transplant patients for complex biliary calculi

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal IV1 Apr 20121933 PERCUTANEOUS ENDOSCOPIC LASER LITHOTRIPSY IN ORTHOTOPIC LIVER TRANSPLANT PATIENTS FOR COMPLEX BILIARY CALCULI Jordan Angell, Brenton Winship, Kelly Healy, Louis Martin, and Kenneth Ogan Jordan AngellJordan Angell Atlanta, GA More articles by this author , Brenton WinshipBrenton Winship Atlanta, GA More articles by this author , Kelly HealyKelly Healy Philadelphia, PA More articles by this author , Louis MartinLouis Martin Atlanta, GA More articles by this author , and Kenneth OganKenneth Ogan Atlanta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2091AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Holmium laser lithotripsy has revolutionized the treatment of urolithiasis in the modern era. Previous work has shown its use in biliary tract calculi as well. We sought to evaluate the use of laser lithotripsy in complex biliary stones in patients who have undergone orthotopic liver transplantation (OLT). METHODS A retrospective review of all OLT patients who underwent percutaneous endoscopic biliary laser lithotripsy (PEBLL) for complex biliary calculi (n=6) from 2005 to 2011 was conducted at our institution. All patients had previously failed treatment with either percutaneous transhepatic cholangiography (PTHC) or endoscopic retrograde cholangiopancreatography (ERCP). All patients had drained biliary systems prior to PEBLL with a percutaneous transhepatic biliary catheter or T-Tube placed by Interventional Radiology. PEBLL was achieved via the established transhepatic tracts with flexible endoscopes. Stones were fragmented with the holmium laser with substantial fragments either manipulated into the jejunal limb of the hepatojejunostomy or removed with a nitinol basket. Stone clearance was verified with intra-operative and post-operative cholangiography. RESULTS Mean patient age was 56.6 years old (32-67 years old). Mean age-adjusted patient Charlson co-morbidity index (CCI) was 8.4. Mean total stone burden was 3cm (1-5cm). 5 patients underwent 6 procedures (PEBLL) with stones being found in the common bile duct (CBD) in 3 patients, and in the hepatic ducts in 5 patients. 3 patients had both CBD and hepatic ductal stones. Only one patient required a second PEBLL to clear stones, the remainder of the cohort was cleared with one procedure. No peri-operative complications were encountered. Mean length of stay was 2.5 days. Mean follow up cholangiography was 10 days; all patients were stone free on post-operative imaging. All patients had their biliary drainage tubes removed. At mean follow up of 10.1 months all patients remained stone free. CONCLUSIONS PEBLL is an alternative treatment modality for complex biliary stones in the OLT patient cohort where other standard treatments have failed. This technique is safe and efficacious, and provides an opportunity to treat complex biliary stone patients with significant medical co-morbidities via a minimally invasive approach. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e780 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Angell Atlanta, GA More articles by this author Brenton Winship Atlanta, GA More articles by this author Kelly Healy Philadelphia, PA More articles by this author Louis Martin Atlanta, GA More articles by this author Kenneth Ogan Atlanta, GA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...