We read with interest the recommendations by Cheung and Kwok1 that the indications for liver resection in patients with complex hepatolithiasis could be extended to include those with intrahepatic strictures and bilateral stones. Of their 52 patients who underwent liver resection for hepatolithiasis, 7 required postoperative choledochoscopy and stone extraction via a T-tube track. After liver resection, the chances of subsequent cholangitis was 13.3% at 5 years and 43% at 10 years.1 No data are provided on the management of these patients who presumably underwent percutaneous transhepatic choledochoscopic intervention. No mention is made of the length of time, duration of hospital stay, or total cost from initial surgery to completion of ultimate stone clearance in those with recurrent stones. While undergoing repeated percutaneous biliary intervention, patients have the discomfort and inconvenience of external T-tubes and stoma appliances to control the invariable and distressing bile leakage around the external biliary catheters. The strategy proposed by Cheung and Kwok also does not provide easy access to all intrahepatic ducts if recurrent calculi develop later after removal of the T-tube.
Jejunal access loop marked with metal clips.
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