Thulium laser-assisted laparoscopic management of intrahepatic stones in recurrent pyogenic cholangitis: A case report and review of minimally invasive approaches.

INTRODUCTION

Recurrent pyogenic cholangitis (RPC) presents significant management challenges, particularly when complicated by large intrahepatic stones. While thulium laser technology has demonstrated excellent results in urological stone treatment, its application in biliary stones remains relatively unexplored. We present a novel approach utilizing laparoscopic choledochoscopy with thulium laser lithotripsy for managing intrahepatic stones in RPC.

CASE PRESENTATION: A 65-year-old female presented with a two-year history of recurrent right upper quadrant pain, fever, and jaundice. Diagnostic imaging revealed multiple large intrahepatic stones without any liver atrophy or mass lesions. After initial ERCP for acute cholangitis management, the patient underwent laparoscopic choledochoscopy with thulium laser lithotripsy. The procedure included stone fragmentation, extraction, and choledochoduodenostomy for long-term biliary drainage. The procedure was successfully completed with minimal blood loss and no intraoperative complications. At 6-month follow-up, the patient remained asymptomatic with normal liver function, despite small retained stones.

DISCUSSION: This approach combines the benefits of minimally invasive surgery with advanced laser technology. Thulium laser offers potential advantages over conventional lithotripsy methods, including enhanced precision and reduced risk of bile duct injury. The successful outcome in this case suggests that this technique may be a viable option for complex hepatolithiasis in RPC.

CONCLUSION

Laparoscopic choledochoscopy with thulium laser lithotripsy represents a promising minimally invasive option for managing intrahepatic stones in RPC. While our case demonstrates technical feasibility, long-term follow-up and larger studies are needed to fully evaluate its efficacy.