Outcome of surgery for recurrent pyogenic cholangitis: a single center experience

Ray, Sukanta; Sanyal, Sumit; Das, Kshaunish; Ghosh, Ranajoy; Das, Somak; Khamrui, Sujan; Sarkar, Avik; Chattopadhyyay, Gautam

doi:10.1016/j.hpb.2016.06.001

Cited by 11 publications

(18 citation statements)

References 35 publications

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“…3,6 A previous study had reported the left lobe, right lobe and both lobes to be involved in 49%, 13% and 38% respectively, which is similar to that observed in this study. 2 If hepatolithiasis is confined to the left liver, liver resection (left hepatectomy or left lateral segmentectomy) is the best treatment. 4,7 In the present study, it was performed in 33% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…3,8 If failed, it should be followed by hepatectomy of the severely affected segments, combined with stone removal, ontable choledochoscopic removal of stones from the remnant liver (with laser lithotripsy) and biliary bypass to prevent recurrence. 2,[9][10][11] Biliary bypass (Roux-en-Y hepatico-jejunostomy) facilitates post-operative natural clearance of residual intrahepatic stones. Bilobar disease is categorized as a high grade disease with greater risk of disease recurrence, often requiring multi-modality treatment for optimal management.…”

Section: Discussionmentioning

confidence: 99%

“…3 In the present study it was seen in 78%, which matches with the published study reports. 2 Similarly, recurrence is the most worrisome part of the hepatolithiasis after all the interventions, hence long-term follow-up is required. It occurs in 20% of patients after complete stone clearance, and is greater for patients having intrahepatic strictures.…”

Section: Discussionmentioning

confidence: 99%

“…Longstanding hepatolithiasis can lead to recurrent pyogenic cholangitis, liver abscess, portal hypertension, secondary biliary cirrhosis and cholangiocarcinoma. 2,3 The disease is more common in East Asia (Taiwan, Japan and Korea) and is endemic in Asia-pacific region, with prevalence as high as 30-50%. 1 It occurs more commonly in 5th to 6th decades of life, with no gender predominance.…”

Section: Introductionmentioning

confidence: 99%

“…Hepatic resection (best option), stone removal with bilio-enteric drainage alone or in combination, and percutaneous transhepatic cholangioscopic lithotomy are the primary treatment modalities. 2,4 The aim of this study was to review the burden and surgical outcomes of patients with hepatolithiasis from an endemic region.…”

Section: Introductionmentioning

confidence: 99%

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Treatment outcome of hepatolithiasis: Nepalese experience

et al. 2020

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Background: Hepatolithiasis is a rare disease with high rate of treatment failure and recurrence. This study aims to review the burden, management and outcome from an endemic region.Methods: A retrospective review of database of patients with hepatolithiasis managed surgically from 2015 to 2019 was performed. Diagnosis was based on the clinical findings and radiological investigations. Demographic data, clinical presentation, extent of disease and type of surgical management were evaluated. The outcome measures included immediate stone clearance, postoperative complications and follow-up.Results: Hepatolithiasis was seen in nine (0.34%) out of 2,600 patients being evaluated for gallstone disease. Three patients were young, while the remaining six were in the middle-age group. The presenting symptoms were pain abdomen (78%) and jaundice (22%). Hepatolithiasis was located in the left, right and both ductal systems in 5, 1 and 3 patients respectively. Liver resection for unilateral disease was done in 3 patients: left hepatectomy (n=2) and left lateral segmentectomy (n=1). High bile duct exploration and bilio-enteric drainage was done in 5 patients. One patient required hepatolithotomy and T-tube drainage due to cholangitis. Complete stone clearance was achieved in 78%. Complications included surgical site infection and cholangitis in 2 patients. There was no operative mortality. Histopathology revealed recurrent pyogenic cholangitis. At median follow-up of 28 months, 7 patients are symptom-free.Conclusions: Hepatectomy is an effective treatment when disease is confined to the left lobe. Combined surgical procedure is an acceptable option for bilateral or right-sided hepatolithiasis.

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