Clinical applications of plasma shock wave lithotripsy in treating postoperative remnant stones impacted in the extra- and intrahepatic bile ducts

Background: Choledochofiberscopy with basket extraction has been used widely to treat postoperative remnant stones in the bile duct system. However, it remains difficult to extract stones impacted in the bile duct system or stones too large to pass through the T-tube fistula. This report describes the efficacy and safety of plasma shock wave lithotripsy (PSWL) in fragmenting and eliminating such remnant stones from the bile duct. Methods: In 52 patients, 117 remnant stories were fragmented with PSWL and subsequently extracted with choledochofiberscopy. The efficacy and safety of PSWL were observed during and after the procedure. Results: After 116 of 117 remnant stones (99.1%) impacted in the extra- and intrahepatic bile ducts were fragmented successfully with PSWL, they were extracted with choledochofiberscopy. There were no significant complications during and after the procedure. Conclusion: It appears that PSWL is an effective and safe method for fragmenting remnant stones impacted in the bile duct system and stones too large to pass through the T-tube fistula.