Subcutaneous implantation of KMC tube for removal of recurrent intrahepatic stones without laparotomy.

About half of 361 patients with intrahepatic stones had recurrent stone(s) requiring additional surgery in the past 10 years. In order to cope with this problem, a new tube referred to as the KMC (Kaohsiung Medical College) tube was developed to allow the removal of stones without additional surgery. This tube was implanted subcutaneously between the common bile duct and the abdominal wall after successful extrication of intra- or extra-hepatic stones. Thirty-nine patients with intrahepatic stones were accepted for this new trial. The surgical procedure consisted of first removing the biliary drainage tube followed by insertion of the KMC tube. The KMC tube was introduced through a small skin incision under local anesthesia and the KMC tube fixed with abdominal fascia. The benefit of this procedure is that the contrast medium could be percutaneously injected into the tube for follow-up cholangiographic study when necessary. The procedure for removal of recurrent stones included removing the KMC tube under local anesthesia, then inserting the choledochofiberscope through the original sinus tract to engage the stone(s) without laparotomy. This procedure had been performed on 4 patients with successful removal of their recurrent stones after 6 to 24 months without the necessity for abdominal surgery.