Parasites and Biliary stones

Hepatolithiasis ٩٠
dilatation). The primary goals of treatment are to eliminate attacks of
cholangitis and to stop the progression of the disease (which leads to
biliary cirrhosis) (Van Sonnenberg et al., 1986). Surgery has a primary
role in hepatolithiasis because hepatolithiasis tends to recur, so that
multiple sessions of the endoscopic approach (i.e. 2-3 times per year) are
often required (Choi et al., 1982). There is no definitive treatment,
reflecting the complicated nature of the disease and various patients’
conditions (Jeng et al., 1999).
Endoscopic approach:
Since obstruction and infection fasten the progression of recurrent
pyogenic cholangitis, therapeutic goals include the complete clearance of
biliary calculi and debris and adequate drainage of the affected segments
of the biliary tree. Although ERCP is useful in the assessment of
anatomy, its role in the treatment of hepatolithiasis is limited. The
treatment of primary intrahepatic stones via the transpapillary route is
difficult if not impossible in many circumstances because of strictures,
peripheral stone impaction, or ductal angulation (Choi and Wong, 1986).
Percutaneous approach:
With technical development of percutaneous transhepatic drainage
and dilation procedures, it is now possible to place catheters into the
intrahepatic duct without laparotomy and to dilate the route up to 18 Fr in
one stage. Moreover, when hepatolithiasis is not confined to one segment
or lobe of the liver, the success rate of PTCS for complete stone removal
and the rate of subsequent stone recurrence are comparable to those of
surgical treatment of hepatolithiasis. However, the efficacy of PTCS for
complete removal of stones is limited in patients with severe biliary
strictures (Cheung et al., 2003).