Original Research
Copyright ©The Author(s) 1997. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 15, 1997; 3(1): 24-26
Published online Mar 15, 1997. doi: 10.3748/wjg.v3.i1.24
Surgical treatment of biliary ductal stricture complicating localized left hepatolithiasis
Wen-Bing Sun, Ben-Li Han, Jing-Xiu Cai, Zhen-Ping He
Wen-Bing Sun, Ben-Li Han, Jing-Xiu Cai, Zhen-Ping He, Hepatobiliary Surgery Center, Southwest Hospital, the Third Military Medical University, Chongqing 630038, China
Wen-Bing Sun, male, born on July 12, 1964 and from Zhanhua County in Shandong Province, graduated from the Second Military Medical University, Associate Professor of Surgery, Vice Surgeon in Charge, specializing in the preventive study of cholangitis-induced liver damage, with 40 published papers
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Wen-Bing Sun, the Third Military Medical University, Chongqing 630038, China
Telephone: +86-811-5318301-73050.
Received: August 29, 1996
Revised: September 29, 1996
Accepted: January 31, 1997
Published online: March 15, 1997

AIM: To summarize the experience in the clinical treatment of biliary duct strictures complicating localized left hepatolithiasis in the last two decades.

METHODS: A retrospective analysis of 67 cases of biliary duct strictures complicating localized left hepatolithiasis treated in our center in the last two decades was made with regards to each patient’s age, gender, results of various preoperative examinations, operative findings, treatment and postoperative courses.

RESULTS: The incidence of left hepatic duct (LHD) stricture was 59.8% and that of a left external hepatic duct (LEHD) stricture was 84.0 % and 84.8% respectively, in which a severe degree dominated. Among the operative procedures used in the treatment of LHD strictures, plastic operation plus biliary enteric anastomosis ranks first in frequency (52.2%), with a re-stricture rate of 17.1%. Left lobectomy ranks third (19.4%) with no re-stricture. Simple plastic performance or dilation had a high occurrence rate of re-stricture and usually needed subsequent surgery. Most LEHD strictures were eradicated by lateral segmentectomy or lobectomy, whereas most LMHD strictures were just the opposite. The rate of preoperative diagnosis of LMHD by endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography, computed tomography or intraoperative and postoperative trans-T-tube cholangiography was much lower than that of LEHD or extrahepatic duct.

CONCLUSION: Too much attention paid to LEHD disorders in the treatment of localized left hepatolithiasis potentially results in negligence or omission in LMHD disorders. Malpractice treatments of LHD strictures are important factors affecting the long term results of localized left hepatolithiasis, for which left lobectomy is usually the therapy of choice.

Keywords: Cholelithiasis/surgery, Bile duct diseases/surgery, Hepatic duct, common/surgery, Cholelithiasis/complication, Hepatectomy