Case Control Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3564-3570
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3564
Hepatectomy with primary closure of common bile duct for hepatolithiasis combined with choledocholithiasis
Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Qi-Fan Qin, Wei-Ming Yu
Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, The Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China
Qi-Fan Qin, Department of General Surgery, Lin’gao County Hospital, Lin’gao 571800, Hainan Province, China
Wei-Ming Yu, Department of General Surgery, Lin’an Municipal Hospital, Lin’an 311300, Zhejiang Province, China
Author contributions: Jia CK, Qin QF and Yu WM performed the operation; Jia CK and Weng J designed the study; Jia CK and Yang QZ wrote the manuscript; Chen YK and Fu Y revised the manuscript.
Supported by Major Program of Science and Technology Bureau of Hainan Province, No. ZDXM2014074; Program of Social Development and Scientific and Technological Projects of Hainan Province, No. SF201422; and Science and Technology Projects of the Education Department of Hainan Province, No. Hjkj2012-25.
Ethics approval: The study was reviewed and approved by the Medical Ethics Board of the Affiliated Hospital of Hainan Medical College.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no potential conflict of interests.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wei-Ming Yu, MD, Department of General Surgery, Lin’an Municipal Hospital, No. 548 Yijin Street, Lin’an 311300, Zhejiang Province, China. 18976452639@126.com
Telephone: +86-898-66789287 Fax: +86-898-66528336
Received: September 19, 2014
Peer-review started: September 21, 2014
First decision: October 29, 2014
Revised: November 24, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: March 28, 2015
Processing time: 191 Days and 17.2 Hours
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.

Keywords: Hepatolithiasis; Choledocholithiasis; Primary closure; Hepatectomy; Biliary drainage

Core tip: We performed hepatectomy with primary closure of the common bile duct for hepatolithiasis combined with choledocholithiasis. Postoperative complications including residual stones, bile leakage, pancreatitis and cholangitis were equivalent in the drainage and non-drainage groups. Postoperative hospital stay and costs were nevertheless significantly less in the non-drainage than in the drainage group. Additional biliary drainage is not necessary for all patients with intrahepatic and extrahepatic calculi, thus avoiding unnecessary discomfort and extra costs. Anatomic hepatectomy followed by intraoperative choledochoendoscopic stone extraction without biliary drainage in selected patients is a safe and effective treatment.