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Chen P, Bai M, Cai R, Chen M, Zhu Z, Wu F, Wang Y, Ding X. The effectiveness of two-step percutaneous transhepatic choledochoscopic lithotripsy for hepatolithiasis: a retrospective study. Updates Surg 2025:10.1007/s13304-025-02118-z. [PMID: 39930257 DOI: 10.1007/s13304-025-02118-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 01/26/2025] [Indexed: 03/17/2025]
Abstract
The study was designed to compare the effectiveness of two-step percutaneous transhepatic choledochoscopic lithotripsy (T-PTCSL) with laparoscopic anatomical hepatectomy combined with choledocholithotomy (LAHC) for patients with hepatolithiasis. From January 2020 to September 2023, 98 patients who underwent LAHC (n = 40) or T-PTCSL (n = 58) for hepatolithiasis in our hospital were included in this study. Their perioperative and long-term outcomes were analyzed. There was no statistical difference between the two groups in stone clearance rates (90.0% vs. 84.5%, P = 0.429) and postoperative complication rates (35.0% vs. 22.4%, P = 0.170). The T-PTCSL group had significantly shorter operative time, postoperative hospitalization, and intake time (all P < 0.001). Postoperative biochemical indices showed lower ALB, ALT, AST, and WBC in the T-PTCSL group compared to the LAHC group (all P < 0.05). Multivariate logistic regression indicated age as an independent risk factor for stone clearance (OR = 0.94, 95% CI = 0.89-0.99, P = 0.049). Subgroup analysis showed no significant impact of gender and type of stone distribution on stone clearance (all P > 0.05). The KM curve analysis revealed no significant difference in stone recurrence between the groups (log-rank P = 0.925). Hemoglobin concentration was significantly associated with time-to-stone recurrence (TR = 1.02, 95% CI = 1.01-1.04, P < 0.05) in the multivariate Accelerated Failure Time Model. T-PTCSL may be an alternative option to LAHC. Compared with LAHC, T-PTCSL offers favorable postoperative recovery and less surgical injury for patients with hepatolithiasis, as well as equivalent effectiveness of stone clearance and recurrence.
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Affiliation(s)
- Peng Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nanan District, Chongqing, China
| | - Mingxin Bai
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan, China
| | - Ruotong Cai
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nanan District, Chongqing, China
| | - Meiling Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nanan District, Chongqing, China
| | - Zheyu Zhu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nanan District, Chongqing, China
| | - Feifan Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nanan District, Chongqing, China
| | - Yunbing Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nanan District, Chongqing, China.
| | - Xiong Ding
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 288 Tianwen Avenue, Nanan District, Chongqing, China.
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Ye YQ, Li PH, Wu Q, Yang SL, Zhuang BD, Cao YW, Xiao ZY, Wen SQ. Evolution of surgical treatment for hepatolithiasis. World J Gastrointest Surg 2024; 16:3666-3674. [PMID: 39734463 PMCID: PMC11650219 DOI: 10.4240/wjgs.v16.i12.3666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/27/2024] [Accepted: 10/11/2024] [Indexed: 11/27/2024] Open
Abstract
Hepatolithiasis is a common disease where stones are located in the intrahepatic bile duct. Hepatolithiasis is a disease with regional characteristics. The complication and postoperative recurrence rates of the disease are high. The intrahepatic cholangiocarcinoma and the incidence of liver cirrhosisare the main causes of death in patients with hepatolithiasis. Thus, it is difficult to treat. The majority of biliary stones are readily removed endoscopically, however complex intrahepatic or large refractory extrahepatic stones often require surgical or percutaneous interventions when standard endoscopic methods fail. At present, the main clinical treatment for hepatolithiasis is surgery, of which there are different methods depending on the patient's condition. With the continuous updates and development of medical technology, the treatment of hepatolithiasis has improved. In this paper, several mainstream surgical methods including partial hepatectomy, choledochojejunostomy, biliary tract exploration and lithotomy, percutaneous transhepatic chledochoscopic lithotripsy and liver transplantation used in the clinic are reviewed for clinicians' reference. Depending on the characteristics of each case, a suitable surgical method is chosen to obtain the best treatment effect.
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Affiliation(s)
- Yong-Qing Ye
- Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
| | - Pei-Heng Li
- Department of Oncology, Foshan Nanhai District Fifth People's Hospital, Foshan 528000, Guangdong Province, China
| | - Qing Wu
- Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
| | - Shang-Lin Yang
- Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
| | - Bao-Ding Zhuang
- Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
| | - Ya-Wen Cao
- Department of Emergency Medicine, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Zhan-Yi Xiao
- Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
| | - Shun-Qian Wen
- Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
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Li Z, Zhang Y, Chen Z, Chen J, Hou H, Wang C, Lu Z, Wang X, Geng X, Liu F. Correlation analysis and recurrence evaluation system for patients with recurrent hepatolithiasis: a multicentre retrospective study. Front Digit Health 2024; 6:1510674. [PMID: 39664398 PMCID: PMC11631919 DOI: 10.3389/fdgth.2024.1510674] [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: 10/13/2024] [Accepted: 10/30/2024] [Indexed: 12/13/2024] Open
Abstract
Background Methods for accurately predicting the prognosis of patients with recurrent hepatolithiasis (RH) after biliary surgery are lacking. This study aimed to develop a model that dynamically predicts the risk of hepatolithiasis recurrence using a machine-learning (ML) approach based on multiple clinical high-order correlation data. Materials and methods Data from patients with RH who underwent surgery at five centres between January 2015 and December 2020 were collected and divided into training and testing sets. Nine predictive models, which we named the Correlation Analysis and Recurrence Evaluation System (CARES), were developed and compared using machine learning (ML) methods to predict the patients' dynamic recurrence risk within 5 post-operative years. We adopted a k-fold cross validation with k = 10 and tested model performance on a separate testing set. The area under the receiver operating characteristic curve was used to evaluate the performance of the models, and the significance and direction of each predictive variable were interpreted and justified based on Shapley Additive Explanations. Results Models based on ML methods outperformed those based on traditional regression analysis in predicting the recurrent risk of patients with RH, with Extreme Gradient Boosting (XGBoost) and Light Gradient Boosting Machine (LightGBM) showing the best performance, both yielding an AUC (Area Under the receiver operating characteristic Curve) of∼0.9 or higher at predictions. These models were proved to have even better performance on testing sets than in a 10-fold cross validation, indicating that the model was not overfitted. The SHAP method revealed that immediate stone clearance, final stone clearance, number of previous surgeries, and preoperative CA19-9 index were the most important predictors of recurrence after reoperation in RH patients. An online version of the CARES model was implemented. Conclusion The CARES model was firstly developed based on ML methods and further encapsulated into an online version for predicting the recurrence of patients with RH after hepatectomy, which can guide clinical decision-making and personalised postoperative surveillance.
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Affiliation(s)
- Zihan Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yibo Zhang
- Department of Analytics, Marketing and Operations, Imperial College London, London, United Kingdom
| | - Zixiang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiangming Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Hou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cheng Wang
- Department of General Surgery, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Zheng Lu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiaoming Wang
- Department of General Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiaoping Geng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fubao Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Predictive factors for subsequent intrahepatic cholangiocarcinoma associated with hepatolithiasis: Japanese National Cohort Study for 18 years. J Gastroenterol 2022; 57:387-395. [PMID: 35357571 DOI: 10.1007/s00535-022-01868-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Predictive factors for intrahepatic cholangiocarcinoma in long-term follow-up of hepatolithiasis are unknown. We thus conducted a cohort study to investigate the predictive factors for developing intrahepatic cholangiocarcinoma in hepatolithiasis. METHODS This cohort is comprised of 401 patients registered in a nationwide survey of hepatolithiasis for 18 years of follow-up. Cox regression analysis was used to elucidate predictive factors for developing intrahepatic cholangiocarcinoma. RESULTS The median follow-up period of patients was 134 months. Twenty-two patients developed intrahepatic cholangiocarcinoma and all died. Identified independent significant factors were as follows: age 63 years or older (hazard ratio [HR] 3.344), residual stones at the end of treatment (HR 2.445), and biliary stricture during follow-up (HR 4.350). The incidence of intrahepatic cholangiocarcinoma in patients with three factors was significantly higher than that in patients with one or two factors. The incidence in the groups with one or two predictive factors was not different. In 88.9% of patients with both biliary stricture and intrahepatic cholangiocarcinoma, the duration between the diagnoses of biliary stricture and intrahepatic cholangiocarcinoma was ≥ 5 years. However, once intrahepatic cholangiocarcinoma developed, 77.8% of patients died within 1 year. Of 24 patients with no symptoms, no previous choledocoenterostomy, no signs of malignancy, no biliary stricture, and no treatment for hepatolithiasis during follow-up, only one developed intrahepatic cholangiocarcinoma. CONCLUSIONS Regarding carcinogenesis, complete stone clearance and releasing biliary stricture can prevent the development of intrahepatic cholangiocarcinoma and improve the prognosis of hepatolithiasis.
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Jin H, Cui M. A propensity score matching study between conventional and soft fiber-optic choledochoscope guided percutaneous transhepatic cholangioscopic lithotripsy for treatment of cholelithiasis. Langenbecks Arch Surg 2021; 407:675-683. [PMID: 34825953 DOI: 10.1007/s00423-021-02359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) provides an alternative method for cholelithiasis treatment. Since conventional rigid choledochoscope applied in PTCSL lacks high flexibility and high-resolution vision, we developed a new, soft fiber-optic choledochoscope (SFCS) to solve these problems. OBJECTIVE We aim to verify the safety and efficacy of PTCSL guided by the newly developed choledochoscope, SCFS. METHODS In this study, a total of 58 patients undergoing PTCSL from November, 2020 to December, 2020 in Zhuhai People's Hospital were enrolled, including 32 patients undergoing conventional PTCSL and 26 patients undergoing SFCS-guided PTCSL. A method of propensity score matching was used in order to balance the pre-operative indexes of the two groups. As a result, a total of 21 pairs (1:1) were created. SFCS-guided PTCSL was performed on patients in the SFCS group for the treatment of cholelithiasis. The operation time, intraoperative blood loss, immediate clearance rate, final clearance rate, postoperative hospitalization time, postoperative complication rate, and recurrence rate were compared between the two groups. A 6-month follow-up was performed for the two groups. RESULTS SFCS-guided PTCSL represents safe and effective treatment outcomes. The immediate clearance rate and final clearance rate in the SFCS group were significantly higher than that of the conventional group. Operation time, intraoperative blood loss, postoperative hospitalization days, and recurrence rate in the SFCS group were significantly lower than that of the conventional group. CONCLUSIONS SFCS applied in PTCSL appears to be a safe and effective method for the treatment of cholelithiasis. This study has been registered in Chinese Clinical Trial Registry as required by legislation (Registration number: ChiCTR1800016864, Registration time: 2018/02/08).
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Affiliation(s)
- Hao Jin
- The Second Department of General Surgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Guangdong Province, 519000, Zhuhai, China
| | - Min Cui
- Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519000, Guangdong Province, China.
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Liang L, Zhuang D, Feng X, Zhang K, Zhi X. The postoperative choledochoscopy in the management of the residual hepatolithiasis involving the caudate lobe: A retrospective study. Medicine (Baltimore) 2021; 100:e26996. [PMID: 34477129 PMCID: PMC8415990 DOI: 10.1097/md.0000000000026996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/31/2021] [Indexed: 01/05/2023] Open
Abstract
To reveal the role of the postoperative choledochoscopy in treating the residual calculi in the caudate lobe (CL) of the liver.We recruited 66 patients with T-tube/percutaneous transhepatic cholangioscopy tract who still had residual gallstones in the CL at least 6 weeks after the operation. Imaging examinations determined the gallstones' locations in the patients, and all of them underwent the postoperative choledochoscopic examination through the T-tube/percutaneous transhepatic cholangioscopy tract for therapeutic intervention.Among the 66 patients, the residual gallstones were mostly located in the Spiegel lobe (48/66, 72.7%), and the residual gallstones that located in the origin of the CL bile branches were successfully determined in the 57 patients (57/66, 86.4%), the remaining 9 patients were unclear because the proximal ducts were severely narrow or even atresia. The mean frequency of the postoperative choledochoscopy was 3.6 (range, 1-10) times. There were 9 patients with complications, and no mortality occurred. In the origin-proved 57 patients, 6 patients failed to remove the gallstones altogether, and the final residual gallstone clearance rate was 77.3% (51/66). There was no significant difference between the Spiegel lobe and the other parts of the CL in determining the bile duct's origins, gallstone clearance rate, and complications. However, the frequency of choledochoscopy in the other parts of the CL was more than in the Spiegel lobe.The postoperative choledochoscopy, an essential method for treating the residual gallstones in the CL, commands high efficiency for calculi extraction and fewer complications. The main reasons for failing to remove the residual gallstones are that the bile duct's origins could not be determined, and the distal bile ducts are atretic in the CL.
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Affiliation(s)
- Li Liang
- Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan, Shandong, China
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Donghai Zhuang
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xianguang Feng
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kai Zhang
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xuting Zhi
- Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan, Shandong, China
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Khayat A, Khayat M, Cline M, Riaz A. Percutaneous Biliary Endoscopy. Semin Intervent Radiol 2021; 38:340-347. [PMID: 34393344 DOI: 10.1055/s-0041-1731372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Biliary endoscopy is underutilized by interventional radiologists and has the potential to become an effective adjunctive tool to help both diagnose and treat a variety of biliary pathology. This is particularly true in cases where endoscopic retrograde cholangiopancreatography fails or is not feasible due to surgically altered anatomy. Both preoperative clinical and technical procedural factors must be taken into consideration prior to intervention. In this article, clinical evaluation, perioperative management, and procedural techniques for percutaneous biliary endoscopy are reviewed.
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Affiliation(s)
- Adam Khayat
- NYU Long Island School of Medicine, Mineola, New York
| | - Mamdouh Khayat
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Cline
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ahsun Riaz
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Chen JM, Yan XY, Zhu T, Chen ZX, Zhao YJ, Xie K, Liu FB, Geng XP. T-tube drainage versus choledochojejunostomy in hepatolithiasis patients with sphincter of Oddi laxity: study protocol for a randomized controlled trial. Trials 2020; 21:586. [PMID: 32600474 PMCID: PMC7322885 DOI: 10.1186/s13063-020-04483-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/06/2020] [Indexed: 11/14/2022] Open
Abstract
Background Residual and recurrent stones remain one of the most important challenges of hepatolithiasis and are reported in 20 to 50% of patients treated for this condition. To date, the two most common surgical procedures performed for hepatolithiasis are choledochojejunostomy and T-tube drainage for biliary drainage. The goal of the present study was to evaluate the therapeutic safety and perioperative and long-term outcomes of choledochojejunostomy versus T-tube drainage for hepatolithiasis patients with sphincter of Oddi laxity (SOL). Methods/design In total, 210 patients who met the following eligibility criteria were included and were randomized to the choledochojejunostomy arm or T-tube drainage arm in a 1:1 ratio: (1) diagnosed with hepatolithiasis with SOL during surgery; (2) underwent foci removal, stone extraction and stricture correction during the operation; (3) provided written informed consent; (4) was willing to complete a 3-year follow-up; and (5) aged between 18 and 70 years. The primary efficacy endpoint of the trial will be the incidence of biliary complications (stone recurrence, biliary stricture, cholangitis) during the 3 years after surgery. The secondary outcomes will be the surgical, perioperative and long-term follow-up outcomes. Discussion This is a prospective, single-centre and randomized controlled two-group parallel trial designed to demonstrate which drainage method (Roux-en-Y hepaticojejunostomy or T-tube drainage) can better reduce biliary complications (stone recurrence, biliary stricture, cholangitis) in hepatolithiasis patients with SOL. Trial registration Clinical Trials.gov: NCT04218669. Registered on 6 January 2020.
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Affiliation(s)
- Jiang-Ming Chen
- Department of Surgery, The First Affiliated Hospital of Anhui Medical University, Wanshui Road 120#, Gaoxin District, Hefei, 230022, Anhui, China
| | - Xi-Yang Yan
- Department of Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230022, Anhui, China
| | - Tao Zhu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Tianehu Road 1#, Administrative District, Hefei, 230022, Anhui, China
| | - Zi-Xiang Chen
- Department of Surgery, The First Affiliated Hospital of Anhui Medical University, Wanshui Road 120#, Gaoxin District, Hefei, 230022, Anhui, China
| | - Yi-Jun Zhao
- Department of Surgery, The First Affiliated Hospital of Anhui Medical University, Wanshui Road 120#, Gaoxin District, Hefei, 230022, Anhui, China
| | - Kun Xie
- Department of Surgery, The First Affiliated Hospital of Anhui Medical University, Wanshui Road 120#, Gaoxin District, Hefei, 230022, Anhui, China
| | - Fu-Bao Liu
- Department of Surgery, The First Affiliated Hospital of Anhui Medical University, Wanshui Road 120#, Gaoxin District, Hefei, 230022, Anhui, China.
| | - Xiao-Ping Geng
- Department of Surgery, The First Affiliated Hospital of Anhui Medical University, Wanshui Road 120#, Gaoxin District, Hefei, 230022, Anhui, China
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New management of hepatolithiasis: Can surgery be avoided? (with video). GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:188-192. [PMID: 32122681 DOI: 10.1016/j.gastrohep.2019.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/18/2019] [Accepted: 11/24/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The presence of hepatolithiasis (HL) is prevalent in eastern countries. It is a clinical entity which is rarely reported in non-surgical series because the standard treatment is the surgical option. Currently, treatment has evolved, with the use of endoscopic techniques being increased and the number of hepatectomies being decreased. SpyGlass™ is a small-calibre endoscopic direct cholangiopancreatoscopy developed to explore and perform procedures in the bile and pancreatic ducts. Single-operator peroral cholangioscopy (POC) is an endoscopic technique useful for treating difficult bile duct stones. AIMS To assess the usefulness, efficacy, and safety of POC with the SpyGlass™ system in patients with HL. PRIMARY OBJECTIVES to achieve technical success of the procedure and clinical success of patients with HL. STUDY DESIGN AND PATIENTS Retrospective, single-centre cohort study of patients with HL from April 2012 to August 2018. SpyGlass™ was chosen in symptomatic patients referred from the surgery unit as the first-line procedure. To perform electrohydraulic lithotripsy (EHL), we used a Northgate Autolith IEHL generator with a 0.66-mm biliary probe. RESULTS We performed a total of 13 procedures in 7 patients with HL. The mean age was 46 years (range 35-65) and 3/7 of patients were female. We achieved technical success in 5/7 cases (71.4%) and clinical success in 4/7 cases (57%). DISCUSSION SpyGlass™ is safe and effective in the treatment of HL. With these results, we confirm the need for management of patients with HL in a multidisciplinary team. When the endoscopic approach is the option, this procedure must be performed by experts in advanced endoscopy.
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Herr A, Collins D, White M, Mandato K, Keating L, Stark C, Lee H, Siskin G. Percutaneous Biliary Endoscopy for Stones. Tech Vasc Interv Radiol 2019; 22:127-134. [DOI: 10.1053/j.tvir.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kedia P, Tarnasky PR. Endoscopic Management of Complex Biliary Stone Disease. Gastrointest Endosc Clin N Am 2019; 29:257-275. [PMID: 30846152 DOI: 10.1016/j.giec.2018.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Choledocholithiasis is a common disorder that is managed universally by endoscopic retrograde cholangiopancreatography (ERCP). For difficult or complex stones, ERCP with conventional techniques may fail to achieve biliary clearance in 10% to 15% of cases. This review summarizes the literature regarding the current available endoscopic techniques for complex stone disease, including mechanical lithotripsy, endoscopic papillary large balloon dilation, cholangioscopy-guided lithotripsy, and endoscopic ultrasound-guided biliary access.
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Affiliation(s)
- Prashant Kedia
- Division of Gastroenterology, Department of Medicine, Methodist Dallas Medical Center, 221 West Colorado Boulevard, Pavillion II, Suite 630, Dallas, TX 75208, USA.
| | - Paul R Tarnasky
- Division of Gastroenterology, Department of Medicine, Methodist Dallas Medical Center, 221 West Colorado Boulevard, Pavillion II, Suite 630, Dallas, TX 75208, USA
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Li EL, Yuan RF, Liao WJ, Feng Q, Lei J, Yin XB, Wu LQ, Shao JH. Intrahepatic bile duct exploration lithotomy is a useful adjunctive hepatectomy method for bilateral primary hepatolithiasis: an eight-year experience at a single centre. BMC Surg 2019; 19:16. [PMID: 30717712 PMCID: PMC6360740 DOI: 10.1186/s12893-019-0480-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background To evaluate the perioperative and long-term results of intrahepatic bile duct exploration lithotomy (IHBDIL) combined with hepatectomy for patients with complicated bilateral primary hepatolithiasis. Methods A study was conducted involving 56 patients with complicated bilateral primary hepatolithiasis who underwent IHBDIL combined with hepatectomy at our hospital from January 2006 to December 2014. The perioperative and long-term outcomes that were retrospectively analysed included the stone clearance rate, operative morbidity and mortality, and stone recurrence rate. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded. Results In all 56 patients, hepatic duct stones were located in the bilateral IHBD. The surgical method was IHBDIL combined with hepatectomy. Postoperative complications occurred in 15 patients (26.8%), 14 patients responded to conservative management, and there was 1 case of postoperative mortality because of hepatic failure. The overall initial success rate of stone clearance was 85.7%, and the final clearance rate was 92.9% following postoperative choledochoscopic lithotripsy. The stone recurrence rate was 13.5%, and the occurrence of postoperative cholangitis was 10.9% during the follow-up period. Conclusion IHBDIL combined with hepatectomy is a safe, effective, and promising treatment for patients with complicated bilateral primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for complicated bilateral primary hepatolithiasis. Electronic supplementary material The online version of this article (10.1186/s12893-019-0480-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- En-Liang Li
- Department of Hepatobiliary and Pancreatic surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, China.,Zhejiang University school of Medicine, HangZhou, China
| | - Rong-Fa Yuan
- Department of Hepatobiliary and Pancreatic surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wen-Jun Liao
- Department of Hepatobiliary and Pancreatic surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian Feng
- Department of Hepatobiliary and Pancreatic surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jun Lei
- Department of Hepatobiliary and Pancreatic surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang-Bao Yin
- Department of Hepatobiliary and Pancreatic surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lin-Quan Wu
- Department of Hepatobiliary and Pancreatic surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Jiang-Hua Shao
- Department of Hepatobiliary and Pancreatic surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, China
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Chen G, Tian F, Zhao X, Chen Y, Peng T, Cui J, Li D, He Y, Wang S. Perihilar Hepatectomy for Hepatolithiasis with Compressed Hilar Bile Duct Induced by Perihilar Hyperplasia of Liver. J INVEST SURG 2018; 33:505-513. [PMID: 30543132 DOI: 10.1080/08941939.2018.1538398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Stone recurrence is a major problem limiting the effects of surgical treatment for hepatolithiasis. It was showed that hyperplasia of perihilar liver may compress the hepatic portal and cause deficient bile flow because of compressed hilar bile duct, thereby leading to the formation of bile stasis and precipitating stone recurrence. This retrospective study aimed to evaluate the efficiency of perihilar hepatectomy for hepatolithiasis with compressed hilar bile duct induced by perihilar hyperplasia of liver. Methods: 135 patients with compressed hilar bile duct induced by hypertrophied perihilar liver were included in this study from January 2011 to July 2016. Among these patients, 77 underwent conventional operation procedure (control group) and 58 underwent conventional operation procedure added by perihilar hepatectomy (perihilar hepatectomy group). Clinical data containing preoperative data, intraoperative data, operation complications, and short-term and long-term outcomes were collected. Results: The demographic and disease-related characteristics of the two groups were comparable. The two groups were not remarkably different in operation-related characteristics. The incidence of bile leakage in the perihilar hepatectomy group was substantially higher than that in the control group. Other postoperative complications were not remarkably different between the two groups. In the long-term postoperative follow-up period, the incidence of the recurrence of stones and cholangitis in the control group was considerably higher than that in the perihilar hepatectomy group. Conclusions: Based on conventional operation procedure, additional perihilar hepatectomy is a reliable intervention with definite clinical effects for hepatolithiasis with compressed hilar bile duct induced by hypertrophied perihilar liver.
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Affiliation(s)
- Guangyu Chen
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
| | - Feng Tian
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xin Zhao
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yan Chen
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
| | - Tao Peng
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jingchi Cui
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
| | - Dajiang Li
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yu He
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
| | - Shuguang Wang
- Hepatobiliary Surgery Institute, Southwest Hospital, Army Medical University, Chongqing, China
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Incidence and Prognosis of Subsequent Cholangiocarcinoma in Patients with Hepatic Resection for Bile Duct Stones. Dig Dis Sci 2018; 63:3465-3473. [PMID: 30171402 DOI: 10.1007/s10620-018-5262-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Cholangiocarcinoma (CCA) often develops after the hepatic resection for hepatolithiasis as well as indwelling it. We studied the incidence and prognosis of subsequent CCA in patients with hepatolithiasis in South Korea. METHODS We identified individuals with diagnosed CCA at the time of or after surgery, during 2002-2016, from the Korean National Health Insurance. The incidences and survival rates of subsequent CCA were analyzed and compared with concomitant CCA. The standardized incidence ratios (SIRs) of CCA in this cohort were evaluated in the standard Korean population. All data were stratified by the presence of intrahepatic or extrahepatic CCA, age and sex. RESULTS Of the 7852 patients with hepatectomy for BDS, 433 (5.84%) had concomitant CCA. Over the 12-year follow-up, 107 of 7419 (1.98%) patients were diagnosed with subsequent CCA. Patients with hepatic resection for BDS revealed higher SIRs for subsequent CCA (12.89, 95% CI 10.96-15.15) in cases of both intrahepatic CCA (13.40, 10.55-17.02) and extrahepatic CCA (12.42, 9.98-15.46). The median survival time for subsequent CCA was 0.87 years, while that for concomitant CCA was 2.79 years. Having subsequent CCA (HR 2.71, 95% CI 2.17-3.40) and being male (HR 1.28, 1.05-1.57) were related to a shorter survival time. The CCA site and age at CCA diagnosis were not related to prognoses. CONCLUSIONS Subsequent CCA developed in 2% of the patients with hepatic resection for benign BDS until 10 years and was associated with poorer prognoses than concomitant CCA. Future studies focused on the long-term surveillance for CCA in such patients are needed.
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Suzuki Y, Mori T, Yokoyama M, Kim S, Momose H, Matsuki R, Kogure M, Abe N, Isayama H, Nakazawa T, Notohara K, Tanaka A, Tsuyuguchi T, Tazuma S, Takikawa H, Sugiyama M. A proposed severity classification system for hepatolithiasis based on an analysis of prognostic factors in a Japanese patient cohort. J Gastroenterol 2018; 53:854-860. [PMID: 29119290 DOI: 10.1007/s00535-017-1410-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/31/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hepatolithiasis frequently results in severe complications. We conducted a cohort study to identify prognostic factors and to establish a hepatolithiasis severity classification system. METHODS The study cohort comprised 396 patients who were identified through a 1998 nationwide survey and followed up for 18 years or until death. Cox regression analysis was used to identify prognostic factors. RESULTS Median survival time of the patients was 308 (range 0-462) months. Of the 396 patients enrolled in the study, 118 (29.8%) died, most frequently from intrahepatic cholangiocarcinoma (25 patients, 21.2%). Age of ≥ 65 years at the time of initial diagnosis [hazard ratio (HR) 3.410], jaundice for ≥ 1 week during follow-up (HR 2.442), intrahepatic cholangiocarcinoma (HR 3.674), and liver cirrhosis (HR 5.061) were shown to be significant risk factors for death from any therapeutic course. The data led to a 3-grade disease severity classification system that incorporates intrahepatic cholangiocarcinoma and liver cirrhosis as major factors and age of ≥ 65 years and jaundice for ≥ 1 week during follow-up as minor factors. Survival rates differed significantly between grades. CONCLUSIONS The proposed hepatolithiasis severity classification system can be used to assess prognosis and thereby improve patient outcomes.
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Affiliation(s)
- Yutaka Suzuki
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Toshiyuki Mori
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Masaaki Yokoyama
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Sangchul Kim
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hirokazu Momose
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Ryota Matsuki
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Masaharu Kogure
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takahiro Nakazawa
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Susumu Tazuma
- Department of General Medicine, Graduate School of Medical Science, Hiroshima University, Hiroshima, Japan
| | - Hajime Takikawa
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Sugiyama
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Minimally invasive surgery versus open hepatectomy for hepatolithiasis: A systematic review and meta analysis. Int J Surg 2018; 51:191-198. [DOI: 10.1016/j.ijsu.2017.12.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/14/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022]
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Meng ZW, Han SH, Zhu JH, Zhou LY, Chen YL. Risk Factors for Cholangiocarcinoma After Initial Hepatectomy for Intrahepatic Stones. World J Surg 2017; 41:835-843. [PMID: 27766397 DOI: 10.1007/s00268-016-3752-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aggressive hepatectomy is effective in treating intrahepatic stones and may minimize the deleterious consequences of subsequent cholangiocarcinoma (S-CCA). The risk factors of S-CCA after different methods of hepatectomy may vary with the resection scope of stone-affected segments. METHODS We reviewed the records of 981 patients of primary intrahepatic stones with elective hepatectomy from January 2000 to December 2010. The clinical characteristics of patients in the S-CCA group (n = 55) and the control group (n = 926) were compared. The uniformity between extent of liver resection (ELR) with stone-affected segments (SAS) was segmented into 2 varieties: ELR = SAS with ELR < SAS according to the different hepatic resection scopes. Cox regression model with forward selection was used to identify the risk factors of S-CCA. RESULTS In the univariate analysis, significant differences were observed between the S-CCA and control groups concerning stone location (unilateral 43.6 and 65.2 %, bilateral 56.4 and 34.8 %), residual stones (32.7 and 11.6 %), hepaticojejunostomy (43.6 and 30.9 %), and uniformity between ELR with SAS (ELR = SAS 20.0 and 42.6 %, ELR < SAS 80.0 and 57.4 %). Residual stones [hazard ratio (HR) 2.101, P = 0.016], hepaticojejunostomy (HR 1.837, P = 0.026) and uniformity between ELR and SAS (HR 2.442, P = 0.013) were independent prognostic factors for S-CCA by a Cox regression analysis with forward selection. In the subsection of ELR = SAS group, the 5- and 10-year postoperative tumor occurrence rates of unilateral and bilateral stones group were 0.9 versus 1.9 % and 3.0 versus 4.1 %, respectively (P = 0.663, log-rank). In the other subsection of ELR < SAS group, the 5- and 10-year postoperative tumor occurrence rates of unilateral and bilateral stones group were 3.4 versus 3.9 % and 6.8 versus 13.2 %, respectively (P = 0.047, log-rank), and the 5- and 10-year postoperative tumor occurrence rates of residual stones and non-residual stones group were 5.8 versus 3.0 % and 16.0 versus 7.9 %, respectively (P = 0.015, log-rank). CONCLUSIONS Patients who underwent aggressive hepatectomy and had ELR = SAS had better outcomes than those with ELR < SAS. In the patients with ELR = SAS, the S-CCA rates of unilateral and bilateral stones were low and comparable. However, patients with ELR < SAS and bilateral intrahepatic or residual stones should be monitored more carefully for high-risk factors of S-CCA.
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Affiliation(s)
- Ze-Wu Meng
- Department of Hepatobiliary Surgery, The Affiliated Union Hospital of Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, China
| | - Sheng-Hua Han
- Department of Hepatobiliary Surgery, The Affiliated Union Hospital of Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, China
| | - Jin-Hai Zhu
- Department of Hepatobiliary Surgery, The Affiliated Union Hospital of Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, China
| | - Liang-Yi Zhou
- Department of Hepatobiliary Surgery, The Affiliated Union Hospital of Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, China
| | - Yan-Ling Chen
- Department of Hepatobiliary Surgery, The Affiliated Union Hospital of Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, China.
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Enliang L, Rongshou W, Shidai S, Jingling Z, Qian F, Wenjun L, Linquan W. Simple resection of the lesion bile duct branch for treatment of regional hepatic bile duct stones. Medicine (Baltimore) 2017; 96:e7414. [PMID: 28682899 PMCID: PMC5502172 DOI: 10.1097/md.0000000000007414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
To evaluate the effectiveness and safety of simple resections of bile duct branch lesions for the treatment of regional hepatic bile duct stones.A retrospective analysis of the clinical data from patients in our hospital from November 2008 to November 2015, who only underwent a simple resection of the lesion bile duct branch. The patients' clinical characteristics, surgical features, postoperative complications, stone clear rate, residual stone rate, and recurrence stone rate were analyzed.This study of 32 patients included 13 males and 19 females with intrahepatic bile duct stones confined to the right hepatic bile duct branch. The intraoperative blood loss, operation time, and postoperative hospital stay were 478.0 ± 86.5, 210.7 ± 6.6, and 10.8 ± 3.5, respectively. Postoperative complications occurred in 6 patients (18.8%), all of whom recovered with conservative management. There were no deaths during hospitalization. The intraoperative stone clearance rate was 95.8%. Three patients had a recurrence of stones at a mean of 22 months of follow-up (range, 4-36 months).Simple resection of bile duct branch lesions is safe and feasible for patients who have regional hepatic bile duct stones limited to the right hepatic bile duct branches.
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Affiliation(s)
- Li Enliang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang
| | - Wu Rongshou
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical College, Ganzhou
| | - Shi Shidai
- Department of General Surgery, Jian Central People's Hospital, Jian
| | - Zhang Jingling
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
| | - Feng Qian
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang
| | - Liao Wenjun
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang
| | - Wu Linquan
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang
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Li EL, Feng Q, Yang QP, Liao WJ, Liu WW, Huang Y, Wu LQ, Yin XB, Shao JH. Effectiveness of hepatic parenchyma lithotomy of hepatolithiasis: A single-center experience. Medicine (Baltimore) 2017; 96:e6134. [PMID: 28272201 PMCID: PMC5348149 DOI: 10.1097/md.0000000000006134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To investigate the clinical significance of hepatic parenchyma incision by lithotomy near the second hepatic portal area for the treatment of complex hepatolithiasis.A retrospective study was conducted with 35 patients who had complicated hepatolithiasis in our hospital from January 2008 to December 2013, who underwent hepatic parenchyma incision by lithotomy near the second hepatic portal area. The perioperative and long-term outcomes included the stone clearance rate, operative morbidity and mortality, and the stone recurrence rate. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded from the study.All patients with hepatic duct stones were mainly located at S2, S4, and S8 regions. Surgical methods included were hepatic parenchyma incision by lithotomy near the second hepatic portal area, or by combined partial hepatectomy. The mean follow-up period was 51 months. One patient died during hospitalization. The surgical morbidity was 17.6%, stone clearance rate was 88.2%, and final clearance rate was 94.1% followed by postoperative choledochoscopic lithotripsy. The stone recurrence rate was 15.6% and the occurrence of postoperative cholangitis was 11.8% during the follow-up period.Hepatic parenchyma incision by lithotomy near the second hepatic portal area is safe with satisfactory short and long-term outcome results for complicated hepatolithiasis.
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Affiliation(s)
- En Liang Li
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University
| | - Qian Feng
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University
| | - Qing Ping Yang
- Center of Assisted Reproduction, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wen Jun Liao
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University
| | - Wang Wei Liu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University
| | - Yong Huang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University
| | - Lin Quan Wu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University
| | - Xiang Bao Yin
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University
| | - Jiang Hua Shao
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University
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Comparison Between Percutaneous Transhepatic Rigid Cholangioscopic Lithotripsy and Conventional Percutaneous Transhepatic Cholangioscopic Surgery for Hepatolithiasis Treatment. Surg Laparosc Endosc Percutan Tech 2016; 26:54-9. [PMID: 26679679 PMCID: PMC4736300 DOI: 10.1097/sle.0000000000000222] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Percutaneous transhepatic cholangioscopy (PTCS) is one option for treating hepatolithiasis without surgical resection. This approach can use conventional biliary drainage methods over a long period, but a shorter procedure needs to be evolved. Objective: To evaluate the short-term and the long-term therapeutic outcomes of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in comparison with conventional PTCS. Methods: In this retrospective study, 118 patients with hepatolithiasis were enrolled who underwent treatment in our hospital between March 2007 and July 2014. About 67 of them received PTCSL and the remaining 51 patients received conventional PTCS. Preoperative data, surgical operation-related records, the postoperative therapeutic effect, and the long-term hepatolithiasis recurrence rate were collected for comparison between the 2 groups. Results: The age, sex, and surgical history were similar between the 2 groups, but there was a significant difference in the Child-Pugh score, with more grade 3 patients in the PTCS group (P=0.002). However, the operation time, intraoperative blood infusion, and the blood loss were similar between the 2 groups. The final clearance ratio of calculus in the PTCSL group was significantly better than in the PTCS group after multivariate analysis (P=0.021; OR=0.201; 95% CI, 0.051-0.785). Calculus recurrence was 9% (PTCSL) and 22% (PTCS). The postoperative hospital stay was significantly shorter in the PTCSL group (P=0.001; OR=1.337; 95% CI, 1.132-1.58). Conclusions: PTCSL was a satisfactory therapeutic option for hepatolithiasis treatment, with less operation time and a superior long-term therapeutic effect compared with conventional PTCS.
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RETRACTED: Long-Term Outcomes of Hepatectomy for Bilateral Hepatolithiasis with Three-Dimensional Reconstruction: A Propensity Score Matching Analysis. J Laparoendosc Adv Surg Tech A 2016; 26:680-8. [DOI: 10.1089/lap.2016.0165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Abstract
BACKGROUND Endoscopy lithotomy (percutaneous transhepatic cholangioscopic lithotomy or through a T-tube track) has become a well-established treatment for intrahepatic gallstones. However, the relationship between strictures and the results of this treatment is still controversial. MATERIALS AND METHODS We searched PubMed, EMBASE, Cochrane Library databases, clinicaltrails, CBM, and Google scholar systematically for all articles. The rate of complete clearance, the recurrence rate, and major complications were analyzed. A meta-analysis was performed by RevMan 5.2. RESULTS Thirteen studies were included. In patients with intrahepatic duct stricture, the rate of complete clearance was significantly lower, but the rate of recurrence was significantly higher. The morbidity rate of major complications was significantly lower in complete stone removal patients. CONCLUSIONS Intrahepatic biliary stricture is a major cause of treatment failure for intrahepatic stones and stone recurrence. To prevent recurrent cholangitis or cholangiocarcinoma, complete removal of intrahepatic gallstones is very important.
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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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Kim HJ, Kim JS, Joo MK, Lee BJ, Kim JH, Yeon JE, Park JJ, Byun KS, Bak YT. Hepatolithiasis and intrahepatic cholangiocarcinoma: A review. World J Gastroenterol 2015; 21:13418-13431. [PMID: 26730152 PMCID: PMC4690170 DOI: 10.3748/wjg.v21.i48.13418] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 02/07/2023] Open
Abstract
Although the incidence of hepatolithiasis is decreasing as the pattern of gallstone disease changes in Asia, the prevalence of hepatolithiasis is persistently high, especially in Far Eastern countries. Hepatolithiasis is an established risk factor for cholangiocarcinoma (CCA), and chronic proliferative inflammation may be involved in biliary carcinogenesis and in inducing the upregulation of cell-proliferating factors. With the use of advanced imaging modalities, there has been much improvement in the management of hepatolithiasis and the diagnosis of hepatolithiasis-associated CCA (HL-CCA). However, there are many problems in managing the strictures in hepatolithiasis and differentiating them from infiltrating types of CCA. Surgical resection is recommended in cases of single lobe hepatolithiasis with atrophy, uncontrolled stricture, symptom duration of more than 10 years, and long history of biliary-enteric anastomosis. Even after resection, patients should be followed with caution for development of HL-CCA, because HL-CCA is an independent prognostic factor for survival. It is not yet clear whether hepatic resection can reduce the occurrence of subsequent HL-CCA. Furthermore, there are no consistent findings regarding prediction of subsequent HL-CCA in patients with hepatolithiasis. In the management of hepatolithiasis, important factors are the reduction of recurrence of cholangitis and suspicion of unrecognized HL-CCA.
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Cholangiocarcinoma Risk as Long-term Outcome After Hepatic Resection in the Hepatolithiasis Patients. World J Surg 2015; 39:1537-42. [PMID: 25648078 DOI: 10.1007/s00268-015-2965-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hepatolithiasis is a well-known risk factor of cholangiocarcinoma. Despite advances in diagnostic modalities, diagnosing cholangiocarcinoma in patients with hepatolithiasis still challenging and there are not enough reports on the incidence of cholangiocarcinoma in patient with hepatolithiasis after treatment. We aimed to evaluate the incidence and clinical characteristics of cholangiocarcinoma in patients with hepatolithiasis who underwent liver resection or non-resection. METHODS Among a total of 257 patients who received treatment for hepatolithiasis, 236 patients were eligible for analysis. Exclusion criteria were follow-up period less than 9 months, preoperative diagnosis of cholangiocarcinoma, occurrence of cholangiocarcinoma within 1 year after treatment. Completeness of stone clearance was defined when there was no intrahepatic duct stone during whole follow-up period. A retrospective study was done to analyze the patients' characteristics, the results and complications of the procedure, and the long-term outcomes for these patients. Kaplan-Meier method and cox proportional regression were used for statistical analysis. RESULTS 95 patients underwent hepatic resection (resection group) and 144 patients did not (non-resection group). Complete stone clearance was 71% (67/95) in resection group and 41% (58/141) in non-resection group (p < 0.001). The incidence of cholangiocarcinoma was 6.8% (16/236) during follow-up period (mean 41 ± 41 months). Cholangiocarcinoma occurred 6.3% (6/95) and 7.1% (10/141) in resection and non-resection group, respectively. There was no significant difference in survival between two groups (p = 0.254). In analysis of according to completeness of stone clearance regardless of treatment modality, cholangiocarcinoma incidence was higher in patients with residual stone (10.4%) than complete stone removal (3.3%) (p = 0.263). On multivariate analysis, none of the factors (age, gender, CA19-9, stone location, bile duct stenosis, liver atrophy, stone recurrence, residual stone, and hepatic resection) showed relationship with the incidence of cholangiocarcinoma. CONCLUSION Hepatic resection for hepatolithiasis is considered to have a limited value in preventing cholangiocarcinoma and the patients should be carefully followed even after hepatic resection. A combination of different treatment modalities is necessary to decrease the residual stone and improve the outcome of the patients with hepatolithiasis.
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Meng YP, Chai XQ, Chu HP, Yang X. Application of hepatic resection in hepatolithiasis. Shijie Huaren Xiaohua Zazhi 2014; 22:5001-5004. [DOI: 10.11569/wcjd.v22.i32.5001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the value of hepatic resection in the treatment of hepatolithiasis.
METHODS: The clinical data for 130 patients with hepatolithiasis who underwent hepatectomy from June 2005 to May 2014 were retrospectively analyzed.
RESULTS: Left lateral hepatic lobectomy was performed in 87 patients, left hepatectomy in 19 patients, quadrate lobe resection in 9 patients, regular hepatic resection in 8 patients, partial right lobe resection with left lateral lobectomy in 3 patients, right hepatectomy with left lateral lobectomy in 1 patient, and left medial hepatic resection in 3 patients. The stone clearance rate was 87%. Fifteen patients were discovered to have cholangiocarcinoma, and 13 cases had residual stones. Postoperative complications included incision infection, bile leakage, pneumonia, and pleural effusion. One patient died of liver failure preoperatively.
CONCLUSION: Hepatectomy is a safe and effective treatment for hepatolithiasis. Adequate preoperative evaluation and reasonable surgical procedure can help reduce or avoid biliary tract reoperation.
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Zhang GW, Lin JH, Qian JP, Zhou J. Identification of risk factors for intraoperative hemobilia and its correlation with early postoperative complications in patients with hepatolithiasis. Am J Surg 2014; 209:260-7. [PMID: 25190546 DOI: 10.1016/j.amjsurg.2014.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/04/2014] [Accepted: 05/15/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study intends to determine the risk factor(s) for intraoperative hemobilia in patients with hepatolithiasis and examine whether the occurrence of intraoperative hemobilia influences the rate of early postoperative complications. METHODS A retrospective analysis of 867 eligible patients was performed. Patients were divided into 2 groups: group A (hemobilia, n = 76) and group B (nonhemobilia, n = 791). RESULTS The incidence of intraoperative hemobilia was 8.8% (76/867). Independent risk factors of intraoperative hemobilia for patients with hepatolithiasis were interval between surgery and latest attack of acute cholangitis less than or equal to 38.8 days; preoperative attack of acute severe cholangitis; and intrahepatic duct stricture. Group A had a higher incidence of early postoperative complications than group B. Shorter interval between surgery and latest attack of acute cholangitis correlated with intraoperative hemobilia and postoperative complications. CONCLUSION The severity and time of onset of preoperative acute cholangitis influence the risk of intraoperative hemobilia, which is positively correlated with early postoperative complications.
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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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