Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12865-12872
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12865
Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma for hepatolithiasis
Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou
Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
Author contributions: Lian YG, Xu Z and Zhou XS designed the research; Lian YG, Zhang WT, Xu Z, Ling XF, Wang LX, Hou CS, Wang G and Cui L performed the research; Lian YG and Zhang WT analyzed the data; and Lian YG wrote this paper.
Institutional review board statement: The study was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no potential conflict of interests.
Data sharing statement: 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: Zhi Xu, MD, Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan Beilu, Beijing 100191, China. xuzhi123456@sohu.com
Telephone: +86-10-82267331 Fax: +86-10-62010334
Received: June 2, 2015
Peer-review started: June 3, 2015
First decision: June 19, 2015
Revised: July 9, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: December 7, 2015
Processing time: 187 Days and 0.6 Hours
Abstract

AIM: To evaluate the long-term outcomes of Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS) and risk factors for recurrence in hepatolithiasis.

METHODS: From March 1993 to December 2012, 202 consecutive patients with hepatolithiasis underwent OSPCHS at our department. The Oddi sphincter preserved procedure consisted of common hepatic duct exploration, stone extraction, hilar bile duct plasty, establishment of subcutaneous stoma to the bile duct. Patients with recurrent stones can undergo stone extraction and/or biliary drainage via the subcutaneous stoma which can be incised under local anesthesia. The long-term results were reviewed. Cox regression model was employed to analyze the risk factors for stone recurrence.

RESULTS: Ninety-seven (48.0%) OSPCHS patients underwent hepatic resection concomitantly. The rate of surgical complications was 10.4%. There was no perioperative death. The immediate stone clearance rate was 72.8%. Postoperative cholangioscopic lithotomy raised the clearance rate to 97.0%. With a median follow-up period of 78.5 mo (range: 2-233 mo), 24.8% of patients had recurrent stones, 2.5% had late development of cholangiocarcinoma, and the mortality rate was 5.4%. Removal of recurrent stones and/or drainage of inflammatory bile via subcutaneous stoma were conducted in 44 (21.8%) patients. The clearance rate of recurrent stones was 84.0% after subsequent choledochoscopic lithotripsy via subcutaneous stoma. Cox regression analysis showed that residual stone was an independent prognostic factor for stone recurrence.

CONCLUSION: In selected patients with hepatolithiasis, OSPCHS achieves excellent long-term outcomes, and residual stone is an independent prognostic factor for stone recurrence.

Keywords: Hepatolithiasis; Stone recurrence; Sphincter of Oddi; Hepaticoplasty; Hepatectomy

Core tip: The treatment of hepatolithiasis remains a great challenge among various biliary operations. Residual and recurrent stones are the most troublesome problem after surgery. The present study introduces an optional technique (OSPCHS) for hepatolithiasis. This procedure keeps the Oddi sphincter intact and reduces the postoperative reflux cholangitis, and OSPCHS also stresses the clearance of hepatobiliary lesions. Moreover, OSPCHS provides the recurrent patients with the minimal invasive treatment to avoid major surgery. OSPCHS generates a satisfactory long-term outcome for hepatolithiasis.