Salvage laser lithotripsy for hepatolithiasis in complex biliary anatomy: a case report.

Introduction: Hepatolithiasis is the presence of gallstones in the bile ducts above the hepatic ducts' confluence. This condition can cause serious issues like cholangitis and biliary cirrhosis in cases involving post-hepaticojejunostomy. Treatment options for hepatolithiasis include percutaneous transhepatic, endoscopic, and surgical approaches, with laser lithotripsy being effective for difficult stones, and helping to avoid more invasive surgeries like hepatectomy. Case presentation: We hereby report a case of a 59-year-old woman with a history of multiple surgeries for hepaticojejunostomy strictures and cholangitis who underwent successful laser lithotripsy for hepatolithiasis. Discussion: Hepatolithiasis is particularly prevalent in the Asia-Pacific region. Diagnosis of hepatolithiasis usually begins with an ultrasound, but MRCP provides a more detailed view of the biliary tree, offering better clarity for assessing conditions like biliary dilatation and strictures. Our patient, who had undergone Roux-en-Y hepaticojejunostomy, presented with multiple intrahepatic and common hepatic duct stones along with an anastomotic stricture. Traditional treatments failed to remove the stones. However, IHBR laser lithotripsy via open surgery effectively resolved the issue, demonstrating a successful strategy for complex biliary conditions. Conclusion: Laser lithotripsy effectively treats hepatolithiasis in complex biliary anatomy, overcoming challenges when standard treatments fail.