World Congress of Gastroenterology

WCOG 2019

New Surgical Technique Applied in Multiple Giant Hepatolithiasis Patients: Ultra-mini Percutaneous Hepatolithotomy First 6 cases
Mehmet Giray Sönmez 1 Faruk Aksoy 2 Süleyman Bakdık 3 Gökhan Ecer 1 Ahmet Atıcı 1 Ahmet Öztürk 1

1- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
2- Department of General Surgery, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
3- Department of Radiology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey


 Introduction:  The aim of the treatment is to clear the stones and restore bile drainage. In the past, liver resection was the first treatment option for these stones.Because of the high morbidity and mortality rates in open surgical management, new ways to eliminate intrahepatic stones have begun to be searched.Therefore, less invasive percutaneous transhepatic cholangioscopy (PTK)andERCP has been used in the treatment of these stones.  However, since the anatomy of the biliary tract is different and does not significantly reduce the intrahepatic stone burden, these therapies are not sufficientEspecially in patients with hepatolithiasis with large stone load.These treatments are used for liverstones less than 1 cm. Despite the fact that percutaneous different treatments were applied to patients with hepatolitiasis in the literature, Ultra-Mini Percutaneous Hepatolithotomy (UM-PHL) was not applied to any patient before.  UM-PHL was used for the first time in this case series and was given this name due to the small size of the instruments used.

We present the Ultra-Mini Percutaneous Hepatolithotomy (UM-PHL) experience we had through minimal dilatation with minimal invasive tools in six patients who had multiple surgery many times due to gall ducts Stones


Cases Presentation:

First patient:Twenty three yearsold female patient had portoenterostomy and cholecystectomy operation whenshe wastwo monthsold due to choledoch cystThere were stones in the intrahepatic bile ducts of the patient who had recurrent cholangeitis and pancreatitis attacks ,Open choledoch cyst resection and wirsung jejunostomy operations were made a year ago due to the continuing complaints of the patient, Previous treatments failed due to high stone load. 


Second patient:Thirty nine years old male patient He has ERCP and MRCP procedure  because of distal choledoc  stone(21mm) ten years ago. He has also cholecystectomy  and choledochoduodenostomy   operations  after ERCP/MRCP. He applied hospital with stomacache and jaundice. He was made percutanous transhepatic cholangiography and ERCP.


Third Patient:A seventy seven years old male patient , He has cholesistectomy story because of cholelithiasis four years ago. In last three years,  many times ERCP and percutaneous  drainage catheter procedure made. A year ago he has been operated Roux-en-Y choledochojejunostomy .

Fourth Patient: 38 years old Male. The patient was diagnosed with Caroli Disease when he was 17 years old and had complaints of intrahepatic biliary tract dilatation when he presented with fever and right upper quadrant pain.He had recurrent cholangitis attacks in her follow-ups.


Fifth Patient:30 years old female. She has cholecystectomy and hepaticojejunostomy operation six years ago.


Sixth Patient:80 years old male.  He had cholecystectomy four years ago.There was a history of ERCP that failed 3 times.



Surgical Tecnique: Details of the surgical technique are described in the video.


All of the stones in the  three patient’ s intrahepatic bile ducts were removed (stone-free).  The patients didnt have any problems in the postoperative follow-ups. The third or fourth day after the procedure, the drains were taken and the patient was discharged on the third or fourth day. 


Conclusions:  In hepatolithiasis patients with high stone load, it is a safe and successful method to clean the stones by providing minimal dilatation through percutaneous intervention regardless of the surgical story in bile ducts and using instruments with a small diameter and pneumatic lithotriptor.  We think that UM-PHL procedure done by surgeons who have years of experience in percutaneous nephrolithotomy field and are skilled in percutaneous surgery would decrease stone-free state and morbidity ratios and increase surgical success.






 Hepatolithiasis, Percutaneous  Hepatolithotomy, Minimal Invasive Surgery, Stone load