Complete removal of complex gallstones with just a small hole in the abdominal skin

21/07/2022 09:08

On 13^th June 2022, Mrs. N.T.H (55 years old, Ha Nam) visited Viet Duc University Hospital because of stomachache, fever and yellow skin in periods since these 3 weeks. She has a history of removing gallstones by surgery for 5 times. After each surgery she has been admitted to hospital multiple times for  examination and treatment so the patient is worried about the complications and has to continue to be operated.

 

At Viet Duc University Hospital, Mrs. N.T.H had doctors checked carefully and performed necessary subclinical examinations, diagnosed the recurrence of  cholangitis due to multiple biliary choledocholithiasis in the liver both sides and common bile duct. Doctors evaluated as a difficult case with a large number of gallstones and complex.

 

Dr. Than Van Sy, MD, MSc– Diagnostic Imaging and Nuclear medicine Center, Viet Duc University Hospital shares: With a large number of gallstones, located in the deep branches of liver parenchyma, and having undergone many surgeries, prognostic as difficult to completely remove all stones through open surgery, the doctors decided to conduct percutaneous gallstone lithotripsy using laser combined with endoscopic system and digital subtraction angiography (DSA) navigation. Results after more than 1 hour of intervention, all the gallstones were completely removed. The procedure is quite gentle and brings many advantages, the patients can stand up, walk and do normal activities right after the procedure.

 

 

According to Dr. Duong Trong Hien, MD, PhD, Head of Emergency Abdominal Surgery Department, Viet Duc University Hospital: Gallstone is a common disease with prevalence from 10 – 15% of population. Open cholecystectomy and cholecystectomy to remove stones with T-tube biliary drain are still popular treatment methods today. However, this is an open surgery therefore, the patients often have painful at incision site and post-operative complications like wound infection, high rate of remaining stone left over if laparoscopic lithotripsy was not used during surgery. Patients with high intrahepatic gallstones often have a high recurrence rate and the next surgeries will be challenging. Percutaneous gallstone lithotripsy would be an excellent alternative option in these cases.

 

 Dr. Le Thanh Dung – MD, PhD, Director of Diagnostic Imaging and Nuclear Medicine Center informed: Laser-based lithotripsy using endoscopic system and DSA navigation is an advance technique, allowing doctors to observe and directly access the stones with just a small hole in the skin instead of open surgery like before. Minimally invasive technique with a small hole in the skin to insert the catheter into the bile duct, put the endoscopic tube and laser canopy, all stones will be scattered and sucked out. The patient is still conscious during the intervention, no pain; After the intervention, the patient quickly recovers and leaves no scar.

 

 

With this method, biliary stones will be accessed directly, then uses laser gun with appropriate energy to break the stones into small pieces and suck out. The rate of clean stones of this technique is really high, up to 95-97%, even with large stones, stones locate in difficult locations, molded stones inside the bile duct. Moreover, this method is also safe, with complication rate especially low. The patient does not require general anesthesia, and can be awake, working almost immediately after the procedure, it can be applied even with cases have underlying diseases, high rate or having contraindication for open surgery.

 

 At the present, Diagnostic Imaging and Nuclear Medicine Center, Viet Duc University Hospital had and performing regular laser lithotripsy technique, which helps many patients are able to be treated effectively.