Retained Intrahepatic Stones

Burhenne, H J; Peters, H. E.

doi:10.1001/archsurg.1978.01370190059010

Cited by 10 publications

(1 citation statement)

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“…Nonoperative extraction of biliary calculi has been reported recently [27][28][29][30][31][32][33][34][35][36][37][38][39]; however, in our series with intrahepatic biliary strictures, the treatment failure rate of stone extraction (rate of retained calculi) without dilatation therapy is high---up to 100%. With the addition of dilatation therapy, the treatment failure rate decreased significantly to 5.3%.…”

Section: Discussionmentioning

confidence: 73%

Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis

et al. 1990

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To investigate the role of balloon dilatation in the management of complicated hepatolithiasis with intrahepatic biliary stricture, 57 consecutive patients who received 208 sessions of dilatation in addition to the usual treatment were analyzed. The strictures were located in the right intrahepatic ducts (84.2%), left intrahepatic ducts (12.3%), or both (3.5%). Dilatation began 3-4 weeks after surgery. The routes of dilatation included the matured T-tube tract (3 cases), percutaneous transhepatic biliary drainage tracts (42 cases), and both (12 cases). The immediate overall success rate of complete stone clearance increased significantly from 0% predilatation to 94.7% postdilatation. The main complications of dilatation therapy consisted of septicemia (10.5%), hemobilia (10.5%), and mild diarrhea (80%). Eight patients (14%) with long-segment strictures received 11 postdilatation biliary stentings. Complications were 1 patient with occlusion and 2 patients with "spontaneous" hemobilia. Severe multiple strictures and coexistent secondary biliary cirrhosis were the contributing factors to complications. During the follow-up of 3.4 +/- 1.2 years, recurrence of strictures was found in 4 patients. Two of them belonged to the stenting group. The cumulative probability of restricture was low: 4% at 2 years, 6% at 2.5 years, and 8% at 3 years. We conclude that in complicated cases of hepatolithiasis with intrahepatic biliary stricture, dilatation and stenting are good adjuvant therapies.

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Section: Discussionmentioning

confidence: 73%

Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis

et al. 1990

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Bile duct stents in the management of hepatolithiasis with long-segment intrahepatic biliary strictures

Jeng

Yang

Chiang

et al. 1992

Journal of British Surgery

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Biliary stricture represents a challenging problem in the treatment of hepatolithiasis because of its association with treatment failure and stone recurrence. The long-segment type of stricture is difficult to manage and is likely to recur. To investigate the necessity for biliary stenting after balloon dilatation therapy, 20 consecutive patients with long-segment strictures who had 22 stents (group 1) were compared with ten patients who refused stenting (group 2). The long-segment strictures in group 1 were located on the right side in 80 per cent of patients, on the left side in 10 per cent, and were bilateral in 10 per cent. The stents, varying from 8 to 12 Fr, were retained for at least 6 months. They were inserted through the routes of a matured T tube track (five cases), percutaneous transhepatic track (14 cases), a jejunal limb (two cases) and a fistula (one case). Complications of stenting consisted of dislodgement (one case), haemobilia (two cases), cholangitis (two cases) and intrahepatic abscess (one case). The cumulative probability of stricture recurrence in group 1 was 10 per cent, 15 per cent and 21 per cent at 2, 3 and 4 years, respectively, whereas in group 2 it was 80 per cent at 2 years (P less than 0.003). The results suggest that intrahepatic biliary stenting after balloon dilatation appears necessary and helpful in the management of hepatolithiasis with long-segment biliary strictures.

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Burhenne

1988

World j. surg.

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Retained Intrahepatic Stones

Cited by 10 publications

References 11 publications

Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis

Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis

Bile duct stents in the management of hepatolithiasis with long-segment intrahepatic biliary strictures

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