For complex intrahepatic stones, surgeons prefer to resect the segments with severe parenchymal atrophy (most commonly the left side) and leave the right side for lithotomy by intraoperative cholangioscopy. Although hepatectomy and intraoperative lithotomy was concomitantly done in some complex intrahepatic stones, satisfactory stones clearance still could not be achieved. A study related 718 intrahepatic stones showed that rate of residual stones of 38.9 in complex intrahepatic stones. Furthermore, the 5-year and 10-year stone recurrence rates were 16.7% and 34.6% in the study, respectively . For the patients with residual and recurrent stones, repeat bile duct exploration and stone extraction are required. Therefore, in our opinion, constructing a permanent bile duct exploration path could play an important role in these cases.
Percutaneous sinus choledochoscopy, endoscopic intrahepatic bile duct lithotomy, percutaneous transhepatic choledochoscopy and choledocholithotomy play an important role in residual and recurrent biliary tract stones[4–5]. These skills could remove most of the stones with one or more attempts. However, repeated endoscopic treatment, PTCS and choledocholithotomy mean huge cost and repeated trauma. With the development of lithotripsy and choledochoscopic technology, a convenient and efficient bile duct exploration path could play an important role in complicated intrahepatic stones. Beyond these, we put forward the hypothesis of "constructing a permanent bile duct exploration path through the left hepatic duct". During the process, we just need to build a biliary exploration channel between the left hepatic duct stump and abdominal wall. However, it could be easily achieved following left hepatectomy.
Bile duct exploration via the constructed path shares the same skills with percutaneous transhepatic choledochoscopy and laparoscopic bile duct exploration via the left hepatic duct, therefore, this technique could be easily handed. For complicated intrahepatic stones, T-tube is usually required to deal with the residual stones. It is worth noting that the constructed bile duct exploration channel could substitute the T-tube perfectly. Because of being buried in abdominal wall, the new technique could avoid the complications of T-tube replacement.
Herein, we shared a new re-operational strategy for the patients with complicated intrahepatic stones via building a permanent bile duct exploration channel between the left hepatic duct and abdominal wall. In our opinion, the technique could play an important role in the re-operation of the patients with complicated intrahepatic stones. In the following steps, we will construct animal models to evaluate the security, durability and histocompatibility of the bile duct exploration channel after long time implantation into the animal body. Therefore, it has lots of works to do before the technique applied to the patients.