Percutaneous transhepatic choledochoscopic lithotripsy for bile duct stones in elderly patients: a case report and technical summary

Background The clinical management of elderly patients with complex intra- and extrahepatic bile duct stones and a history of multiple abdominal surgeries is often challenging. The development of PTCSL offers a novel therapeutic option for this population. Case summary An 82-year-old male with extensive, complex hepatolithiasis and concomitant choledocholithiasis was transferred to our institution for definitive treatment following PTCD placement at another hospital. The patient had undergone three prior abdominal surgeries (open cholecystectomy, choledocholithotomy, and partial enterectomy) and coronary stent implantation for coronary artery stenosis 6 months prior. PTCSL was successfully performed to completely clear the biliary calculi. No stone recurrence was observed during 1-year follow-up. Integrating contemporary literature with the authors’ technical experience, we summarize critical procedural insights to advance clinical implementation of this technique. Conclusion Two-step PTCSL represents a safe and effective therapeutic option for elderly patients with complex intra- and extrahepatic bile duct stones and multiple high-risk factors. Comprehensive preoperative planning combined with judicious utilization of surgical instruments can significantly enhance procedural efficacy and safety.