Publications (2)11.68 Total impact
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ABSTRACT: It has been over 20 years since percutaneous transhepatic cholangioscopic lithotomy (PTCSL) or left lateral segmentectomy with postoperative cholangioscopy (POC) was applied in treating isolated left-sided hepatolithiasis (ILH). However, their efficacy in treating ILH is not elucidated clearly in the literature. A retrospective study was conducted in 59 patients with ILH undergoing either PTCSL or left lateral segmentectomy with POC during the past 22 years. The mean period of followup was 10.8 years (1-22 years). Hepatolithiasis restricted in the left external hepatic duct (LEHD), whose stones can be cleared by left lateral segmentectomy without undergoing POC, was only found in 17% (10/59) of the patients with ILH. The overall complication rate of left lateral segmentectomy with POC was 22% (4/18), and of PTCSL was 17% (7/41). Either in patients with (82%, 9/11 vs. 71%, 12/17; p > 0.05) or without intrahepatic ducts (IHDs) stricture (100%, 7/7 vs. 92%, 22/24; p > 0.05) in the liver remnant, the rates of complete stone clearance were comparable between left lateral segmentectomy with POC and PTCSL. The stone recurrence rate and cumulative nonrecurrence rate in patients with IHDs stricture in the liver remnant were also comparable between left lateral segmentectomy with POC and PTCSL (p > 0.05). Nevertheless, hepatolithiasis did not recur in patients without IHD stricture in the liver remnant after left lateral segmentectomy with POC, whose stone recurrence rate was lower than those without (0%, 0/7 vs. 50%, 10/20; p = 0.026) or with (0%, 0/7 vs. 7/12, 58%; p = 0.017) IHDs stricture undergoing PTCSL. After undergoing left lateral segmentectomy with POC, the cumulative nonrecurrence rate was also higher in patients without IHDs stricture in the liver remnant than those with IHDs stricture in the liver remnant (p < 0.05). Left lateral segmentectomy with POC and PTCSL have comparable efficacy in treating ILH. However, no stone recurs when ILH are completely removed without IHD stricture left in the liver remnant after left lateral segmentectomy with POC. The presence of IHDs stricture in the liver remnant is the major factor contributing to ILH recurrence after successful left lateral segmentectomy with POC.
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ABSTRACT: Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) for the treatment of hepatolithiasis is particularly suited for those patients who are poor surgical risks or who refuse surgery and those with previous biliary surgery or stones distributed in multiple segments. However, hepatolithiasis is characterized by high rates of treatment failure and recurrence. We examined the long-term results of 245 patients with hepatolithiasis treated by PTCSL. This was a retrospective study of 245 patients who underwent PTCSL for hepatolithiasis; the patients were followed for 1-22 yr to evaluate the immediate and long-term results. Sonography was used to search for stone recurrence every year or whenever the patients presented symptoms suggestive of cholangitis. Cholangiography and/or CT were performed to verify recurrence. PTCSL achieved complete clearance of hepatolithiasis in 209 patients (85.3%); the rate of incomplete clearance was higher in patients with intrahepatic duct stricture (29/118, 24.6% vs 7/127, 5.5%; p = 0.002). The rate of major complications was 1.6% (4/245) and included liver laceration (n = 2), intra-abdominal abscess (n = 1), and disruption of the percutaneous transhepatic biliary drainage fistula (n = 1). The overall recurrence rate of hepatolithiasis and/or cholangitis was 63.2%. The absolute rate of stone recurrence was not significantly related to the presence of intrahepatic duct stricture (51/89, 56.2% vs 53/120, 44.4%; p = 0.08), although the median time to recurrence was less in those with stricture (11 vs 18 yr; p = 0.007). In the patients without intrahepatic duct stricture, the rate of complete stone clearance was not related to the presence of dilation (34/38, 89.5% vs 86/89, 96.6%; p = 0.196), but the recurrence rate was higher in those with dilation (20/34, 58.8% vs 33/86, 38.4%; p = 0.042). Among the 209 patients with a successful initial PTCSL, the incidence of recurrent cholangitis or cholangiocarcinoma was significantly higher in those with incompletely removed recurrent hepatolithiasis than in those without coexisting hepatolithiasis (44.3%, 27/61 vs 16.2%, 24/148; p < 0.001 and 6.6%, 4/61 vs 0.7%, 1/148; p = 0.026). PTCSL is a relatively safe and effective procedure for treating hepatolithiasis. Long-term follow-up is required because the overall recurrence rate of hepatolithiasis and/or cholangitis is high. The rate of complete stone clearance and the median time to stone recurrence are less in the presence of stricture, but the absolute rate of stone recurrence is not significantly related to stricture. In the absence of stricture, the rate of stone recurrence is higher in patients with dilated intrahepatic duct. Complete stone clearance is necessary, because the incidence of recurrent cholangitis or cholangiocarcinoma is higher in patients with incomplete clearance of recurrent hepatolithiasis.
Show Chwan Memorial HospitalChang-hua Pei-pu, Taiwan, Taiwan