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Wu JY, Huang WT, He WB, Dai GF, Lv JH, Qiu FN. Long-term outcomes of anatomic vs. non-anatomic resection in intrahepatic cholangiocarcinoma with hepatolithiasis: A multicenter retrospective study. Front Med (Lausanne) 2023; 10:1130692. [PMID: 37020678 PMCID: PMC10067634 DOI: 10.3389/fmed.2023.1130692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/24/2023] [Indexed: 04/07/2023] Open
Abstract
Background The benefits of anatomic resection (AR) vs. non-anatomic resection (NAR) in patients with primary intrahepatic cholangiocarcinoma (ICC) with hepatolithiasis (HICC) are unclear. This study aimed to compare the long-term outcomes of AR vs. NAR in patients with HICC. Methods A total of 147 consecutive patients with HICC who underwent R0 hepatectomy were included. Overall survival (OS) and recurrence-free survival (RFS) following AR vs. NARs were compared using a 1:1 propensity score matching (PSM) analysis. A subgroup analysis was also conducted according to whether there are lymph node metastases (LNM). Results In a multivariate analysis, CA 19-9 (>39 U/L), microvascular invasion, LNM, and NAR were independent risk factors for poor RFS and OS rates, whereas multiple tumors were independent risk factors for OS. AR had better 1-, 3-, and 5-year RFS and OS rates than NAR (OS: 78.7, 58.9, and 28.5%, respectively, vs. 61.2, 25.4, and 8.8%, respectively; RFS: 59.5, 36.5, and 20.5%, respectively, vs. 38.2, 12.1, and 6.9%, respectively). After PSM, 100 patients were enrolled. The NAR group also had significantly poorer OS and RFS (OS: 0.016; RFS: p = 0.010) than the AR group. The subgroup analysis demonstrated that in HICC without LNM, OS and RFS were significantly poorer in the NAR group than the AR group, while no significant differences were observed in HICC with LNM before or after PSM. Conclusion Anatomic resection was associated with better long-term survival outcomes than NAR in patients with HICC, except for patients with LNM.
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Affiliation(s)
- Jun-Yi Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Wen-Tao Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Wen-bin He
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Gao-Fan Dai
- Department of Surgical Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jia-Hui Lv
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Fu-Nan Qiu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Fu-Nan Qiu
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Pu T, Chen JM, Li ZH, Jiang D, Guo Q, Li AQ, Cai M, Chen ZX, Xie K, Zhao YJ, Wang C, Hou H, Lu Z, Geng XP, Liu FB. Clinical online nomogram for predicting prognosis in recurrent hepatolithiasis after biliary surgery: A multicenter, retrospective study. World J Gastroenterol 2022; 28:715-731. [PMID: 35317276 PMCID: PMC8891727 DOI: 10.3748/wjg.v28.i7.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/20/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Methods for predicting the prognosis of patients undergoing surgery for recurrent hepatolithiasis after biliary surgery are currently lacking.
AIM To establish a nomogram to predict the prognosis of patients with recurrent hepatolithiasis after biliary surgery.
METHODS In this multicenter, retrospective study, data of consecutive patients in four large medical centers who underwent surgery for recurrent hepatolithiasis after biliary surgery were retrospectively analyzed. We constructed a nomogram to predict the prognosis of recurrent hepatolithiasis in a training cohort of 299 patients, following which we independently tested the nomogram in an external validation cohort of 142 patients. Finally, we used the concordance index (C-index), calibra-tion, area under curve, decision curve analysis, clinical impact curves, and visual fit indices to evaluate the accuracy of the nomogram.
RESULTS Multiple previous surgeries [2 surgeries: Odds ratio (95% confidence interval), 1.451 (0.719-2.932); 3 surgeries: 4.573 (2.015-10.378); ≥ 4 surgeries: 5.741 (1.347-24.470)], bilateral hepatolithiasis [1.965 (1.039-3.717)], absence of immediate clearance [2.398 (1.304-4.409)], neutrophil-to-lymphocyte ratio ≥ 2.462 [1.915 (1.099-3.337)], and albumin-to-globulin ratio ≤ 1.5 [1.949 (1.056-3.595)] were found to be independent factors influencing the prognosis. The nomogram constructed on the basis of these variables showed good reliability in the training (C-index: 0.748) and validation (C-index: 0.743) cohorts. Compared with predictions using traditional classification models, those using our nomogram showed better agreement with actual observations in the calibration curve for the probability of endpoints and the receiver operating characteristic curve. Dichloroacetate and clinical impact curves showed a larger net benefit of the nomogram.
CONCLUSION The nomogram developed in this study demonstrated superior performance and discriminative power compared to the three traditional classifications. It is easy to use, highly accurate, and shows excellent calibration.
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Affiliation(s)
- Tian Pu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Jiang-Ming Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Zi-Han Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Dong Jiang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Qi Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ang-Qing Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ming Cai
- Department of General Surgery, The First Affiliated Hospital of the University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Zi-Xiang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Kun Xie
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Yi-Jun Zhao
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Cheng Wang
- Department of General Surgery, The First Affiliated Hospital of the University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Hui Hou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Zheng Lu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Xiao-Ping Geng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Fu-Bao Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Abstract
Hepatolithiasis is highly prevalent in Asia but rare in Western countries. However, the incidence of hepatolithiasis may be increasing in Western countries due to the increased rate of immigration from areas where hepatolithiasis is prevalent. There are many non-surgical treatments for hepatolithiasis, but surgical management remains the best curative treatment for some cases of hepatolithiasis. Surgical treatments can remove biliary stones and relieve stricture of the bile ducts. This review describes the indications for and the outcomes of surgical treatment of hepatolithiasis, including liver resection and liver transplantation.
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Affiliation(s)
- Chuan Li
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tianfu Wen
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
- Address correspondence to: Dr. Tianfu Wen, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China. E-mail:
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Ray S, Sanyal S, Das K, Ghosh R, Das S, Khamrui S, Sarkar A, Chattopadhyyay G. Outcome of surgery for recurrent pyogenic cholangitis: a single center experience. HPB (Oxford) 2016; 18:821-826. [PMID: 27506993 PMCID: PMC5061016 DOI: 10.1016/j.hpb.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/28/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although, recurrent pyogenic cholangitis (RPC) is prevalent in several parts of India, there is paucity of published literature from India. The aim of this study was to report on the short and long-term outcomes of surgery for RPC. METHODS All the patients, who underwent surgery for RPC between August 2007 and February 2016 in the Department of Surgical gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India were retrospectively reviewed. RESULTS Of the total 94 patients, 66 (70%) were women. The median age at presentation was 40 years. Left lobe was solely involved in 49% of patients. Left hepatectomy was performed in 23/44 (52%) patients who underwent liver resection. Thirty two postoperative complications developed in 27 patients (29%). Complete stone clearance was possible in 83% of patients after primary surgery. Over a median follow up of 36 months, seventy one of 87 patients (81%) remained free of stones. Recurrent cholangitis occurred 10 of 87 patients (11%). CONCLUSIONS Surgery plays an important role in the management of RPC achieving excellent short and long-term outcomes.
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Affiliation(s)
- Sukanta Ray
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India,Correspondence Sukanta Ray, Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India. Tel: +91 9830287364. Fax: +91 3322235435.Division of Surgical GastroenterologySchool of Digestive and Liver DiseasesInstitute of Postgraduate Medical Education and Research244 A. J. C. Bose RoadKolkataWest Bengal700020India
| | - Sumit Sanyal
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Kshaunish Das
- Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Ranajoy Ghosh
- G I Pathology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Somak Das
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Sujan Khamrui
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Avik Sarkar
- G I Radiology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Gautam Chattopadhyyay
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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Wang M, Xing Y, Gao Q, Lv Z, Yuan J. Mirizzi syndrome with an unusual aberrant hepatic duct fistula: a case report. Int Med Case Rep J 2016; 9:173-7. [PMID: 27445508 PMCID: PMC4938132 DOI: 10.2147/imcrj.s103566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mirizzi syndrome (MS) is a rare complication of chronic cholelithiasis, which is always caused by a calculus in the cystic duct or neck of the gallbladder, resulting in mechanical compression of common bile duct and the gallbladder. It is clinically characterized by abdominal pain, fever, as well as obstructive jaundice. During cholecystectomy, MS is seen as a dangerous adherent and inflammatory tissue in the area of Calot’s triangle. In the general population, aberrant right posterior hepatic duct, one of the causes of bile duct injury during duct surgery, is present in 4.8%–8.4% of people. Herein we report a rare case of a 76-year-old female patient, with hepatolithiasis of right posterior lobe and cholecysto-aberrant right posterior hepatic duct fistula. This is a special type of MS; however, interestingly, she did not have any symptoms, and the disease was found by physical examination incidentally. This case highlights another situation, namely, there may be difficulty in diagnosing MS and dissecting for operation. Therefore, to avoid the complication associated with this special situation, the surgeons need to diagnose carefully and adopt an optimal treatment strategy.
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Affiliation(s)
- Meng Wang
- Department of General Surgery, The First People's Hospital of Wujiang, Affiliated Wujiang Hospital of Nantong University
| | - Yufei Xing
- Digestive Clinical Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Quangen Gao
- Department of General Surgery, The First People's Hospital of Wujiang, Affiliated Wujiang Hospital of Nantong University
| | - Zhiqiang Lv
- Department of General Surgery, The First People's Hospital of Wujiang, Affiliated Wujiang Hospital of Nantong University
| | - Jianmao Yuan
- Department of General Surgery, The First People's Hospital of Wujiang, Affiliated Wujiang Hospital of Nantong University
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Feng LB, Xia D, Yan LN. Liver transplantation for hepatolithiasis: Is terminal hepatolithiasis suitable for liver transplantation? Clin Transplant 2016; 30:651-8. [PMID: 26947018 DOI: 10.1111/ctr.12731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 02/05/2023]
Abstract
Hepatolithiasis, originally as oriental cholangiohepatitis, especially prevails in Asia, but globalization and intercontinental migration have also converted the endemic disease dynamics around the world. Characterized by its high incidence of ineffective treatment and recurrence, hepatolithiasis, always, poses a therapeutic challenge to global doctors. Although the improved surgical and non-surgical techniques have evolved over the past decade, incomplete clearance and recurrence of calculi are always so common and disease-related mortality from liver failure and concurrent cholangiocarcinoma still exists in the treatment of hepatolithiasis. In the late stage of hepatolithiasis, is it suitable for liver transplantation (LT)? Herein, we propose a comprehensive review and analysis of the LTx currently in potential use to treat hepatolithiasis. In our subjective opinion, and as is objective from the literatures so far, also given the strict indications, LT remains one of the definitive treatments for terminal hepatolithiasis.
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Affiliation(s)
- Li-Bo Feng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sichuan Medical University, Luzhou, China
| | - Dong Xia
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sichuan Medical University, Luzhou, China
| | - Lv-Nan Yan
- Department of General Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China
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Jia CK, Weng J, Chen YK, Yang QZ, Fu Y, Qin QF, Yu WM. Hepatectomy with primary closure of common bile duct for hepatolithiasis combined with choledocholithiasis. World J Gastroenterol 2015; 21:3564-3570. [PMID: 25834321 PMCID: PMC4375578 DOI: 10.3748/wjg.v21.i12.3564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/24/2014] [Accepted: 01/16/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility of hepatectomy and primary closure of common bile duct for intrahepatic and extrahepatic calculi.
METHODS: From January 2008 to May 2013, anatomic hepatectomy followed by biliary tract exploration without biliary drainage (non-drainage group) was performed in 43 patients with intrahepatic and extrahepatic calculi. After hepatectomy, flexible choledochoscopy was used to extract residual stones and observe the intrahepatic bile duct and common bile duct (CBD) for determination of biliary stricture and dilatation. Function of the sphincter of Oddi was determined by manometry of the CBD. Primary closure of the CBD without T-tube drainage or bilioenteric anastomosis was performed when there was no biliary stricture or sphincter of Oddi dysfunction. Dexamethasone and anisodamine were intravenously injected 2-3 d after surgery to prevent postoperative retrograde infection due to intraoperative bile duct irrigation, and to maintain relaxation of the sphincter of Oddi, respectively. During the same period, anatomic hepatectomy followed by biliary tract exploration with biliary drainage (drainage group) was performed in 48 patients as the control group. Postoperative complications and hospital stay were compared between the two groups.
RESULTS: There was no operative mortality in either group of patients. Compared to intrahepatic and extrabiliary drainage, hepatectomy with primary closure of the CBD (non-drainage) did not increase the incidence of complications, including residual stones, bile leakage, pancreatitis and cholangitis (P > 0.05). Postoperative hospital stay and costs were nevertheless significantly less in the non-drainage group than in the drainage group. The median postoperative hospital stay was shorter in the non-drainage group than in the drainage group (11.2 ± 2.8 d vs 15.4 ± 2.1 d, P = 0.000). The average postoperative cost of treatment was lower in the non-drainage group than in the drainage group (29325.6 ± 5668.2 yuan vs 32933.3 ± 6235.1 yuan, P = 0.005).
CONCLUSION: Hepatectomy followed by choledochoendoscopic stone extraction without biliary drainage is a safe and effective treatment of hepatolithiasis combined with choledocholithiasis.
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Liu FB, Yu XJ, Wang GB, Zhao YJ, Xie K, Huang F, Cheng JM, Wu XR, Liang CJ, Geng XP. Preliminary study of a new pathological evolution-based clinical hepatolithiasis classification. World J Gastroenterol 2015; 21:2169-2177. [PMID: 25717253 PMCID: PMC4326155 DOI: 10.3748/wjg.v21.i7.2169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/08/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate clinical features, treatment strategies and outcomes of patients with hepatolithiasis (HL) undergoing surgical treatment, using a new clinical classification.
METHODS: Sixty-eight HL patients were hospitalized and treated surgically from August 2011 to December 2012 and they were classified into four HL types according to pathological evolution of the disease. These four HL types included type I primary type (defined as no previous biliary tract surgery), type II inflammatory type (with previous biliary tract surgery and cholangitis), type III mass-forming type (HL complicated by hepatic mass-forming lesion), and type IV terminal type (with secondary biliary cirrhosis and resultant portal hypertension). The perioperative data including general information, imaging data, postoperative complications, and immediate and final stone clearance rate were obtained and analyzed.
RESULTS: In all 68 patients, the proportion of HL type I-IV was 50% (34/68), 36.8% (25/68), 10.3% (7/68) and 2.8% (2/68), respectively. Abdominal pain was the main clinical manifestation in type I (88.2%), fever was predominant in type II (52.0%), the malignancy rate in type III was high (71.4%), and portal hypertension and spleen enlargement were common in type IV (2/2, 100.0%). Liver resection rate for types I-III was 79.4%, 72.0% and 71.4%, respectively. The overall incidence of postoperative complications was 23.5% (16/68). There were no perioperative deaths. The average length of hospital stay was 12.7 ± 7.3 d. Immediate and final stone clearance rate was 73.5% (50/68) and 89.7% (61/68), respectively. Fifty-nine of 68 patients (86.8%) were followed- up for > 1 year after surgery, and 96.6% of these patients (57/59) had a good quality of life according to a criterion recommended for postoperative evaluation of quality of life.
CONCLUSION: The pathological evolution-based clinical classification of HL has a role in optimizing treatment strategy, and patients can benefit from this classification when it is used properly.
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Zhang GW, Lin JH, Qian JP, Zhou J. Analyzing risk factors for early postoperative bile leakage based on Clavien classification in bile duct stones. Int J Surg 2014; 12:757-61. [PMID: 24909135 DOI: 10.1016/j.ijsu.2014.05.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 05/17/2014] [Accepted: 05/29/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To identify the risk factors of bile leakage, with different severity, based on Clavien-Dindo complication classification system. MATERIALS AND METHODS A retrospective analysis of 943 eligible patients was performed. Sixty-eight patients, with bile leakage, were divided into 2 groups: mild bile leakage (grades I, II, n = 41) and severe bile leakage (grades III, IV, V, n = 27). Twenty-five potential factors were analyzed, by multivariate regression analyses, to identify independent risk factors of bile leakage. RESULTS The independent risk factors of bile leakage, for the entire cohort, included attacks of acute cholangitis within 1 month, associated biliary-enteric anastomosis (BEA), associated hepatectomy and previous biliary surgery. The independent risk factors for patients with mild bile leakage were attacks of acute cholangitis within 1 month, associated hepatectomy, and a history of previous biliary surgery. Similarly, the independent risk factors for patients with severe bile leakage were attacks of acute cholangitis within 1 month, associated hepatectomy, and associated BEA. CONCLUSIONS Risk factors for mild and severe postoperative bile leakage, in bile duct stones, were different.
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Affiliation(s)
- Guo-Wei Zhang
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China.
| | - Jian-Hua Lin
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
| | - Jian-Ping Qian
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
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Cui L, Xu Z, Ling XF, Wang LX, Hou CS, Wang G, Zhou XS. Laparoscopic hepaticoplasty using gallbladder as a subcutaneous tunnel for hepatolithiasis. World J Gastroenterol 2014; 20:3350-3355. [PMID: 24695884 PMCID: PMC3964406 DOI: 10.3748/wjg.v20.i12.3350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/14/2014] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the feasibility, efficacy and safety of laparoscopic hepaticoplasty using gallbladder as subcutaneous tunnel and sphincter-of-Oddi preservation for hepatolithiasis.
METHODS: From January 2010 to July 2013, six patients with hepatolithiasis were treated at our institution. All the patients underwent laparoscopic surgery. The procedures included common hepatic duct exploration, stone clearance by fiberoptic choledochoscopy, hilar bile duct hepaticoplasty with preservation of the sphincter of Oddi, anastomosis between the hilar bile duct and neck of the gallbladder, and establishment of a subcutaneous tunnel with the gallbladder. Two patients underwent left lateral hepatectomy simultaneously. Clinical data including operation time, intraoperative blood loss, operative morbidity, hospital mortality, stone clearance, and recurrence rate were analyzed.
RESULTS: All patients successfully completed laparoscopic surgery. The mean length of hospital stay was 4.5 ± 0.9 d (range: 3-6 d). The mean blood loss of the hepatectomy was 450 mL (range: 200-700 mL), and the blood loss of the other four was 137 ± 151 mL (range: 50-400 mL). The mean operative time was 318 ± 68 min (range: 236-450 min). The operative morbidity and hospital mortality were zero. The immediate stone clearance rate was 100%. All patients were followed up for an average of 17 mo (range: 7-36 mo). One of the six patients had abdominal mass with pain, and subcutaneous tunnel cholangiography showed severe gallbladder-biliary anastomotic stricture at 4 mo postoperatively. There was no stone recurrence and no cholangitis during follow-up.
CONCLUSION: Laparoscopic hepaticoplasty using gallbladder with a subcutaneous tunnel and preserving the sphincter of Oddi is feasible, safe and effective for hepatholithiasis.
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Tian J, Li JW, Chen J, Fan YD, Bie P, Wang SG, Zheng SG. Laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis: an experience of 116 cases. Dig Liver Dis 2013; 45:493-8. [PMID: 23395128 DOI: 10.1016/j.dld.2013.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/29/2012] [Accepted: 01/03/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND An increasing number of patients with hepatolithiasis were diagnosed at an early stage in China. Laparoscopic surgery has introduced new methods of treating this condition. AIM To investigate the patient selection, operative technique, and efficacy of laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis. PATIENTS AND METHODS The clinical data of 116 patients who underwent laparoscopic hepatectomy (laparoscopic group) and 78 patients who underwent open hepatectomy (open group) for hepatolithiasis were retrospectively analyzed, and were compared with the recent reports. RESULTS The laparoscopic group had a longer duration of operation (323.3 ± 103.0 min vs. 272.8 ± 66.8 min, p<0.05) and shorter postoperative hospital stay (13.1 ± 5.6 days vs. 16.5 ± 8.4 days, p<0.05) than the open group. There were no significant differences between the two groups in intraoperative blood loss or transfusion rate, postoperative complications, calculus clearance, calculus recurrence, or recurrent cholangitis (p>0.05 for all). Efficacy in the laparoscopic group was similar to that in other recently reported studies. CONCLUSIONS Laparoscopic hepatectomy with bile duct exploration is safe and feasible for early stage localized hepatolithiasis, with an efficacy similar to that of open surgery. Anatomic hepatectomy is important for achieving good therapeutic outcomes.
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Affiliation(s)
- Ju Tian
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Shapingba District, Chongqing, People's Republic of China
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Jarufe N, Figueroa E, Muñoz C, Moisan F, Varas J, Valbuena JR, Bambs C, Martínez J, Pimentel F. Anatomic hepatectomy as a definitive treatment for hepatolithiasis: a cohort study. HPB (Oxford) 2012; 14:604-10. [PMID: 22882197 PMCID: PMC3461386 DOI: 10.1111/j.1477-2574.2012.00488.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment requirements in hepatolithiasis may vary and may involve a multidisciplinary approach. Surgical resection has been proposed as a definitive treatment. OBJECTIVES This study aimed to evaluate the clinical results of anatomic liver resection among Chilean patients with hepatolithiasis. METHODS An historical cohort study was conducted. Patients who underwent hepatectomy as a definitive treatment for hepatolithiasis from January 1990 to December 2010 were included. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded. Preoperative, operative and postoperative variables were evaluated. RESULTS A total of 52 patients underwent hepatectomy for hepatolithiasis. The mean ± standard deviation patient age was 49.8 ± 11.8 years (range: 24-78 years); 65.4% of study subjects were female. A total of 75.0% of subjects had a history of previous cholecystectomy. The main presenting symptom was abdominal pain (82.7%). Hepatic involvement was noted in the left lobe in 57.7%, the right lobe in 34.6% and bilaterally in 7.7% of subjects. The rate of postoperative clearance of the biliary tree was 90.4%. Postoperative morbidity was 30.8% and there were no postoperative deaths. Three patients had recurrence of hepatolithiasis, which was associated with Caroli's disease in two of them. Overall 5-year survival was 94.5%. CONCLUSIONS Anatomic liver resection is an effective treatment in selected patients with hepatolithiasis and is associated with low morbidity and no mortality. At longterm follow-up, anatomic hepatectomy in these patients was associated with a lower rate of recurrence.
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Affiliation(s)
- Nicolás Jarufe
- Department of Digestive Surgery, Pontifical Catholic University of Chile, Santiago, Chile.
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