Intrahepatic stones ? Surgery-laser lithotripsy (LLT) ?

[Guest guest]

Treatment of Gallstones(calculi) inside Liver.

" To date ten patients have been treated with laser lithotripsy (LLT). "

" With thorough intrahepatic endoscopy, bilateral calculi were found in all

patients (10), demonstrating the futility of hepatic resection for this

desease. "

From:

http://www.ssat.com/97ddw/ddw93.htm

Treatment of primary intrahepatic stones with a holmium laser.

P Shamamian, M Grosso*, A Guth, T Diflo, SG Marcus, GF Coppa, K Eng. SA

Localio Laboratory for General Surgery Research and Department of Urology*,

New York University School of Medicine, New York, NY.

Primary intrahepatic stones (PHS), also known as cholangiohepatitis causes

recurrent cholangitis and eventually leads to hepatic failure and death.

No commonly used therapy has been demonstrated to adequately clear the

intrahepatic ducts of calculi and prevent recurrent sepsis. Present therapy

consisting of biliary enteric bypass and hepatic resection is fraught with

complications and treatment failures. Significant advances in fiberoptic

endoscopy allow exploration of the intrahepatic biliary ducts and the

introduction of endoscopic accessories such as baskets, dilators and laser

fibers. We have adapted these advances in biliary endoscopy with a Holmium

laser lithotripter to treat PHS. The safety and efficacy of Holmium laser

lithotripsy for urinary tract calculi has been demonstrated. The Holmium

laser is ideal for PHS as it provides sufficient energy to " vaporize "

calculi, with minimal risk to adjacent tissue in experienced hands. To date

ten patients have been treated with laser lithotripsy (LLT). Access for LLT

was obtained via percutaneous biliary drains (5) or surgically placed

T-Tube tracts (5). Biliary drainage was established by biliary enteric

bypass (8) or endoscopic sphincterotomy (2). Five patients had prior

surgical therapy including two with left hepatic resections. With thorough

intrahepatic endoscopy, bilateral calculi were found in all patients,

demonstrating the futility of hepatic resection for this desease. At least

three LLT treatments were required for clearance of calculi, and no patient

with complete clearance has represented with biliary sepsis. All segments

of the intrahepatic ducts were accessed for LLT and the Holmium laser was

able fragment calculi regardless of chemical composition. No patient

required liver resection and there were no deaths following LLT. Three

patients had post LLT tachyarrhythmias and one patient developed a

subcapsular hematoma. In 24 patients treated by other methods at our

institution prior to the development of LLT, there were seven major

complications, 10 liver resections and one death. It is therefore clear

that LLT should be the preferred approach to PHS in order to provide stone

clearance, preserve hepatic parenchyma and prevent recurrent sepsis.

Society for Surgery of the Alimentary Tract, Inc.

6900 Grove Road

Thorofare, NJ 08086-9447

USA

telephone: 609-251-0558

fax: 609-848-5274

[Guest guest]

>

>

> Treatment of Gallstones(calculi) inside Liver.

>

>

>

> " To date ten patients have been treated with laser lithotripsy (LLT). "

>

> " With thorough intrahepatic endoscopy, bilateral calculi were found in all

> patients (10), demonstrating the futility of hepatic resection for this

> desease. "

>

>

>

> From:

> http://www.ssat.com/97ddw/ddw93.htm

>

>

>

> Treatment of primary intrahepatic stones with a holmium laser.

> P Shamamian, M Grosso*, A Guth, T Diflo, SG Marcus, GF Coppa, K Eng. SA

> Localio Laboratory for General Surgery Research and Department of Urology*,

> New York University School of Medicine, New York, NY.

>

>

> Primary intrahepatic stones (PHS), also known as cholangiohepatitis causes

> recurrent cholangitis and eventually leads to hepatic failure and death.

>

> No commonly used therapy has been demonstrated to adequately clear the

> intrahepatic ducts of calculi and prevent recurrent sepsis. Present therapy

> consisting of biliary enteric bypass and hepatic resection is fraught with

> complications and treatment failures. Significant advances in fiberoptic

> endoscopy allow exploration of the intrahepatic biliary ducts and the

> introduction of endoscopic accessories such as baskets, dilators and laser

> fibers. We have adapted these advances in biliary endoscopy with a Holmium

> laser lithotripter to treat PHS. The safety and efficacy of Holmium laser

> lithotripsy for urinary tract calculi has been demonstrated. The Holmium

> laser is ideal for PHS as it provides sufficient energy to " vaporize "

> calculi, with minimal risk to adjacent tissue in experienced hands. To date

> ten patients have been treated with laser lithotripsy (LLT). Access for LLT

> was obtained via percutaneous biliary drains (5) or surgically placed

> T-Tube tracts (5). Biliary drainage was established by biliary enteric

> bypass (8) or endoscopic sphincterotomy (2). Five patients had prior

> surgical therapy including two with left hepatic resections. With thorough

> intrahepatic endoscopy, bilateral calculi were found in all patients,

> demonstrating the futility of hepatic resection for this desease. At least

> three LLT treatments were required for clearance of calculi, and no patient

> with complete clearance has represented with biliary sepsis. All segments

> of the intrahepatic ducts were accessed for LLT and the Holmium laser was

> able fragment calculi regardless of chemical composition. No patient

> required liver resection and there were no deaths following LLT. Three

> patients had post LLT tachyarrhythmias and one patient developed a

> subcapsular hematoma. In 24 patients treated by other methods at our

> institution prior to the development of LLT, there were seven major

> complications, 10 liver resections and one death. It is therefore clear

> that LLT should be the preferred approach to PHS in order to provide stone

> clearance, preserve hepatic parenchyma and prevent recurrent sepsis.

>

>

> Society for Surgery of the Alimentary Tract, Inc.

> 6900 Grove Road

> Thorofare, NJ 08086-9447

> USA

>

> telephone: 609-251-0558

> fax: 609-848-5274

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Alice, I certainly found this post extremely interesting. My surgeon told me

they do not use lithotripsy for gallstones, nor actigall. I finally had to have

lap.cholecystectomy in sept 01 for gallstone pancreatitis. There were

approximately 50 black stones in the gall bladder. He could not access any

ducts due to stricture, I still have pain as before surgery only LPT are normal.

I have done a couple flushes with success, but still have pain.

ABD ultrasound is ok, abd,chest,pelvic ct's ok,still have pain. Seeing that I

live in NJ where my surgeon said this procedure is not done, I am anxious to

talk to the Thorofare group, Thanks for info.pat