The postoperative choledochoscopy in the management of the residual hepatolithiasis involving the caudate lobe

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.

Hepatolithiasis followed by recurrent cholangitis as a consequence of inadequate hepaticojejunostomy for common bile duct injury

“…The highest incidence of hepatolithiasis occurs in the 50th to 60th decades of life and has been reported typically between the age 30 to 70. The combination of intra-and extra-hepatic HL is more frequent in the older groups while intrahepatic form of the disease occurs in the younger age groups [1][2][3][4][5][6][7][8][9][10].…”

“…A downward trend has been observed over the years possibly due to improved standards of living and Westernized diet. Increasing incidence of HL has been noted in Western countries with increasing immigration from East Asia to the West [2,3,4].…”

“…Common presence of bacteria in bile and gallstones indicates the possibility of pattern connection between bacterial infection and the formation of brown pigment stones. Escherichia coli, Clostridium and Bacteroides show beta-glucuronidase activity and are most common bacterial species isolated from the bile of patients with hepatolithiasis, Clinically HL may present as acute obstruction and recurrent bacterial cholangitis with all its possible complications, such as liver abscess and septicemic shock, or with chronic complications which refers to cholangiocarcinoma [4][5][6][7][8].…”

Hepatolithiasis: Epidemiology, presentation, classification and management of a complex disease

“…In very complex cases, patients might need to be considered for liver transplantation. Up to 15.6% of patients will require bile duct exploration after hepatectomy, due to incomplete stone clearance[ 98 , 99 ] and as many as 38.5% can present with recurrent hepatolithiasis[ 100 ]. These patients are also at high risk of developing biliary cancer, with as many as 9.7% been diagnosed with concomitant CCA[ 101 ], and up to 12.2% developing subsequent CCA during follow-up[ 102 - 104 ].…”

Effects of laparoscopic and choledochoscopic gallbladder-preserving cholecystolithotomy on levels of operation indicators, gallbladder function, and cholecystokinin type-A receptor in patients with gallstones

“…As a specific receptor in gallbladder smooth muscle, cholecystokinin type-A receptor (CCKAR) is able to promote gallbladder contraction and exert a certain regulatory effect on small intestinal peristalsis. It has been researched that the CCKAR level is closely associated with the postoperative recovery of gastrointestinal function of patients with gallstones [ 7 ]. However, the majority of previous studies focused on laparoscopic cholecystolithotomy, and no uniform conclusion has been made on the influence of laparoscopic and choledochoscopic gallbladder-preserving cholecystolithotomy on serum CCKAR level.…”