Treatment of secondary intrahepatic calculosis

: The secondary intrahepatic stone is generally associated with an extrahepatic stone and depends on it. Since April 1979 to April 1988 10 cases of secondary I.S. have been treated by the authors. Four cases were treated by papillo-sphincterectomy and the stones were removed i.o. by choledochoscopy. Five cases were treated by a B-D anastomosis and the following extraction of the other stones were done by means of transhepatic choledochoscopy. Another case was treated by a B-D anastomosis while the remaining stones were removed by using both transhepatic choledochoscopy and the ESWL, treatment. The I.S. treatment has not been codified yet. The aim is to remove not just the stones but also to eliminate the responsible cause of stenosis. If surgery has been not able to solve the problem, other methodologies might be used in presence of big stones or stones of the fifth or the third segment.