Surgical Management of Intrahepatic Gallstones

Abstract

The results of surgical treatment in 100 patients with intrahepatic gallstones are reported including follow-up on 61 patients who survived more than three years. Nine patients died in the follow-up period, and of the remainder, 44 showed complete rehabilitation (72%). The results of follow-up examinations were best shown by improvement in the tests of hepatic function when compared with the values at the time of discharge. However, in those patients with a long duration of illness, or with residual stones or with impairment of liver function, many claimed persistent complaints and showed abnormal late values of hepatic function. Patients with intrahepatic gallstones are best managed: 1) removal of all gallstones as thoroughly as possible, 2) additional procedures to eliminate bile stasis and permit residual stones to enter the intestinal tract and 3) irrigation of the biliary ducts to remove remaining stones.

Suppression of proliferative cholangitis in a rat model with direct adenovirus-mediated retinoblastoma gene transfer to the biliary tract

“…3,4,15 It develops biliary strictures, bile duct wall thickness, bile retention, and suppurative cholangitis. 3,4 It is the main cause of residual and recurrent stones, [1][2][3][5][6][7]15 which are the most difficult problems in hepatolithiasis treatments. [1][2][3] A number of hepatolithiasis treatment options, including surgical procedures like choledochotomy, hepaticojejunostomy, hepatectomy, and papilloplasty, have been performed.…”

“…In the pathogenesis of hepatolithiasis, cholestasis and biliary infection have been widely accepted as indispensable factors. [1][2][3][4][5] The most characteristic pathological feature is proliferative cholangitis (PC), which shows the peribiliary gland hyperplasia and the proliferation of the biliary epithelium and fibrous tissue, resulting in considerable thickening of the bile duct wall. [3][4][5] PC frequently induces residual and/or recurrent stones, [1][2][3][5][6][7] which are the largest problem after repeated treatments for hepatolithiasis.…”

“…[1][2][3][4][5] The most characteristic pathological feature is proliferative cholangitis (PC), which shows the peribiliary gland hyperplasia and the proliferation of the biliary epithelium and fibrous tissue, resulting in considerable thickening of the bile duct wall. [3][4][5] PC frequently induces residual and/or recurrent stones, [1][2][3][5][6][7] which are the largest problem after repeated treatments for hepatolithiasis. [1][2][3] In the present study, gene therapy using the adenovirus vector encoding nonphosphorylatable, constitutively active form of retinoblastoma gene product (AdRb) was introduced to reduce proliferation caused by PC.…”

“…[3][4][5] PC frequently induces residual and/or recurrent stones, [1][2][3][5][6][7] which are the largest problem after repeated treatments for hepatolithiasis. [1][2][3] In the present study, gene therapy using the adenovirus vector encoding nonphosphorylatable, constitutively active form of retinoblastoma gene product (AdRb) was introduced to reduce proliferation caused by PC. Retinoblastoma (Rb) protein is known to inhibit cell-cycle progression in mammalian cells.…”

“…Cholestasis and biliary infection are considered to play important roles in the formation of intrahepatic stones and to remain even after treatments for hepatolithiasis. [1][2][3][5][6][7] We assumed that inhibition of the formation of proliferative changes in this model could lead to some new adjuvant treatment modality for reducing recurrence of PC and stones after treatments. Therefore, we investigated in the current study whether the adenovirus-mediated overexpression of human Rb into the biliary tract could control the formation of proliferative changes in this model.…”