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lüll Percutaneous endoscopic holmium laser lithotripsy for management of complicated biliary calculi Healy K; Chamsuddin A; Spivey J; Martin L; Nieh P; Ogan KJSLS 2009[Apr]; 13 (2): 184-9BACKGROUND AND OBJECTIVES: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. METHODS: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and post-operatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. RESULTS: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. CONCLUSIONS: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach.|*Hepatic Duct, Common[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Cholecystectomy, Laparoscopic[MESH]|Cholelithiasis/*therapy[MESH]|Cystoscopes[MESH]|Female[MESH]|Gallstones/*therapy[MESH]|Holmium[MESH]|Humans[MESH]|Laser Therapy/*methods[MESH]|Lithotripsy/*methods[MESH]|Male[MESH]|Middle Aged[MESH]|Retrospective Studies[MESH]|Sphincterotomy, Endoscopic[MESH]|Ureteroscopes[MESH] |