Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma for hepatolithiasis

Table 1 Patient characteristics n (%)

	Patients (n = 202)
Age	55 (18-83)
Male:female	75:127
Presentation
Acute cholangitis	36 (67.3)
Jaundice	8 (4.0)
Liver abscess	0
Abdominal pain	54 (26.7)
Acute pancreatitis	4 (2.0)
Previous biliary operation	62
Cholecystectomy	25 (12.4)
Cholecystectomy plus CBD exploration	23 (11.4)
CBD exploration	6 (3.0)
Hepatectomy	8 (4.0)
Concomitant extrahepatic stones	154
GB stones	14 (6.9)
CBD stones	94 (46.5)
GB + CBD stones	46 (22.8)
Stone location
Left	58 (28.7)
Right	34 (16.8)
Both	110 (54.4)
Intrahepatic stricture	118 (58.4)
Liver atrophy	52 (25.7)
Biliary cirrhosis	27 (3.5)

CBD: Common bile duct.

Table 2 Types of operation

	Type of operation	n (%)
Subcutaneous stoma (n = 202)	Gallbladder as a subcutaneous stoma	99 (49.0)
	Free jejunum as a subcutaneous stoma	103 (51.0)
Hepatectomy (n = 97)	Left lateral sectionectomy	65 (67.0)
	Left hepatectomy	19 (19.6)
	Segmentectomy of segment 6	5 (5.2)
	Segmentectomy of segment 5	1 (1.0)
	Left hepatectomy + right anterior segmentectomy	1 (1.0)
	Segmentectomy of segment 3	1 (1.0)
	Segmentectomy of segment 5 + segment 6	1 (1.0)
	Segmentectomy of segment 6 + segment 7	3 (3.1)
	Segmentectomy of segment 7 + segment 8	1 (1.0)

Table 3 Operative short-term outcomes

Short-term outcome	Patients (n = 202)	Management
Complications	21 (10.4)
Biliary leakage	9 (4.5)	Observation for 8 patients, and reoperation for 1 patient
Wound infection	5 (2.5)	Dressing
Intra-abdominal bleeding	2 (1.0)	Observation for 1 patient, and reoperation for 1 patient
Hemobilia	2 (1.0)	Observation for 1 patient, and reoperation for 1 patient
Low limb thrombosis	1 (0.5)	Observation
Pleural effusion	1 (0.5)	Observation
Abdominal fungal infection	1 (0.5)	Antibiotic
Perioperative mortality	0
Immediate stone clearance	147 (72.8)
Final stone clearance	196 (97.0)

Table 4 Long-term outcomes of surgery

Long-term outcome	n (%)
Stone recurrence	50 (24.8)
Recurrent attack of acute cholangitis	28 (13.9)
Utilization of subcutaneous stoma	42 (20.8)
Clearance of recurrent stones	42 (84.0)
Development of cholangiocarcinoma	5 (2.5)
Death	11 (5.4)

Table 5 Risk factors associated with stone recurrence identified with Cox regression model

Variable	Univariate analysis, P value	Multivariate analysis
		HR	95%CI	P value
Age	0.572
Gender	0.883
Previous biliary surgery	0.237
Biliary stenosis	0.689
Extrahepatic stones	0.417
Stone distribution	0.217
Hepatectomy	0.191
Types of subcutaneous stoma	0.414
Residual stones	0.008	2.587	1.396-4.795	0.003