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Motta RV, Saffioti F, Mavroeidis VK. Hepatolithiasis: Epidemiology, presentation, classification and management of a complex disease. World J Gastroenterol 2024; 30:1836-1850. [PMID: 38659478 PMCID: PMC11036492 DOI: 10.3748/wjg.v30.i13.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/23/2024] [Accepted: 03/13/2024] [Indexed: 04/03/2024] Open
Abstract
The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts, above the hilar confluence of the hepatic ducts. The disease is more prevalent in Asia, mainly owing to socioeconomic and dietary factors, as well as the prevalence of biliary parasites. In the last century, owing to migration, its global incidence has increased. The main pathophysiological mechanisms involve cholangitis, bile infection and biliary strictures, creating a self-sustaining cycle that perpetuates the disease, frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of "recurrent pyogenic cholangitis". Furthermore, long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma. Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment. The management of symptomatic patients and those with complications can be complex, and relies upon a multidisciplinary team of hepatologists, endoscopists, interventional radiologists and hepatobiliary surgeons, with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications. This comprehensive review provides insight on various aspects of hepatolithiasis, with a focus on epidemiology, new evidence on pathophysiology, most important clinical aspects, different classification systems and contemporary management.
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Affiliation(s)
- Rodrigo V. Motta
- Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Francesca Saffioti
- Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and University College London, London NW3 2QG, United Kingdom
| | - Vasileios K Mavroeidis
- Department of HPB Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8HW, United Kingdom
- Department of Transplant Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
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Zhang WL, Fang ZP, Shi BY, Chen T, Lv SD, Wang C, Hu P, Zhang FB. Low-pressure pulse flushing choledochoscopy combined with neodymium laser lithotripsy for the treatment of intrahepatic bile duct stones. Hepatobiliary Pancreat Dis Int 2021; 20:383-386. [PMID: 33931315 DOI: 10.1016/j.hbpd.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 04/06/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Wen-Long Zhang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Zhe-Ping Fang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Bin-Yao Shi
- Department of Hepatobiliary Surgery, Enze Hospital, Wenzhou Medical University, Taizhou 318000, China
| | - Ting Chen
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Shang-Dong Lv
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Cheng Wang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Peng Hu
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Fa-Biao Zhang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China.
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Surgical Techniques for the Laparoscopic Treatment of Bile Duct Stones in Patients With a History of Upper Abdominal Operations: Retrospective Cohort Study. Surg Laparosc Endosc Percutan Tech 2020; 29:503-508. [PMID: 31800398 DOI: 10.1097/sle.0000000000000678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Few authors have studied applying the laparoscopic approach in patients with previous upper abdominal operations, but no comparison has been made between laparoscopic and open approaches in patients with previous upper abdominal operations. This article aims to introduce surgical techniques and details in treatment to surgeons specialized in minimally invasive surgery. MATERIALS AND METHODS From January 2010 to January 2018, 460 eligible patients were divided into 3 groups and analyzed retrospectively. Group A: patients with a history of upper abdominal operations who underwent laparoscopy (n=124); group B: patients without a history of upper abdominal operations who underwent laparoscopy (n=140); and group C: patients with a history of upper abdominal operations who underwent an open operation (n=196). Group A was the experimental group; groups B and C served as the control groups. RESULTS No significant difference was found between groups A and B. Significant differences were found between groups A and C in estimated blood loss (258.3±67.2 vs. 424.7±103.7 mL, P<0.001), postoperative hospitalization (5.7±2.3 vs. 10.2±3.1 d, P<0.001), and postoperative complications (16.1% vs. 42.9%, P=0.013). The final rate of stones clearance was 100% in 3 groups. The total rate of stone recurrence was 7.8%. CONCLUSIONS Laparoscopy with certain surgical techniques was feasible, effective, and advantageous for patients with previous upper abdominal operations by experienced surgeons. It is necessary for surgeons to have advanced skills and surgical techniques to achieve a successful laparoscopy.
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Yang T, Ma Z, Xu B, Sun W, Meng H, Liu D, Zhou B, Song Z. Clinical role of frequency-doubled double-pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration. ANZ J Surg 2019; 89:E358-E362. [PMID: 31441206 DOI: 10.1111/ans.15364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The optimal methods for patients with difficult biliary stones remain under debate. The aim of this study was to evaluate the role of frequency-doubled double-pulse neodymium YAG (FREDDY) laser lithotripsy for removing difficult biliary stones during laparoscopic common bile duct exploration (LCBDE). METHODS Between March 2013 and January 2015, 42 consecutive patients with difficult biliary stones who underwent LCBDE with FREDDY laser lithotripsy were included in this study. The clinical data of all patients were retrospectively collected and analysed. RESULTS Bile ducts were completely cleared in all patients. The complications related to laser lithotripsy were not noted. A total of 38 patients (90.5%) underwent primary closure of common bile duct, and T-tube drainage was applied to four patients (9.5%). No bile duct injury, bleeding and perforation were observed. There were no post-operative surgery-related deaths. Bile leakage occurred in four patients (9.5%) with primary closure procedure, and all of them were managed successfully with conservative therapy. The median follow-up period was 42.8 months, with no evidence of bile duct stricture and stone recurrence in all patients. CONCLUSIONS The LCBDE combined with FREDDY laser lithotripsy appear to be effective and safe for the treatment of difficult biliary stones.
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Affiliation(s)
- Tingsong Yang
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Zhilong Ma
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Bin Xu
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Hongbo Meng
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Dalu Liu
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Clinical Medical College of Anhui Medical University, Shanghai, China
| | - Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Zhenshun Song
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
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Fang L, Wang J, Dai WC, Liang B, Chen HM, Fu XW, Zheng BB, Lei J, Huang CW, Zou SB. Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies. Surg Endosc 2018; 32:4742-4748. [PMID: 30298446 DOI: 10.1007/s00464-018-6195-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/20/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND LTCBDE combined with or without modified techniques is safe and efficacious for the management of gallstones and concomitant, even large, common bile duct (CBD) stones. METHODS To describe the surgical indications and procedure strategies of laparoscopic transcystic common bile duct exploration (LTCBDE), a retrospective analysis of 205 patients with concomitant gallstones and CBD stones treated using LTCBDE between June 2008 and June 2015 was performed. Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction (with or without laser lithotripsy), and surgical outcomes were collected and reviewed. RESULTS CBD stones were successfully cleared in all patients. No patient was converted to choledochotomy or laparotomy. The cystic duct diameter ranged 3-8 mm, and 85 patients with cystic duct diameter ≥ 5 mm. The mean time for CBD stone extraction was 25.3 min, with the operative time ranged from 63 to 170 min. Lithotripsy was used in 74 (36.1%) patients among which 26 patients with cystic duct diameter ≥ 5 mm. Estimated blood loss during surgery was 10-120 ml per patient, and no intra-operative blood transfusions were needed. The mean postoperative hospital stay was 5.1 (range 3-7) days, and postoperative complications developed in seven patients. No bile duct injury, stricture, remnant, recurrent stones, or other adverse events were observed during the mean follow-up of 8 months. CONCLUSIONS Based on preoperative MRCP and intra-operative IOC findings about cystic duct diameter, the diameter of CBD, CBD stone size, we summarized and proposed the surgical indications and suitable techniques and strategies during LTCBDE.
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Affiliation(s)
- L Fang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China.
| | - J Wang
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - W C Dai
- Department of General Surgery, Yili Friendship Hospital, Yili, Xinjiang, China
| | - B Liang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - H M Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - X W Fu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - B B Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - J Lei
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - C W Huang
- Department of Hepatobiliary Surgery, The People's Hospital of Jiangxi, Nanchang, Jiangxi, China
| | - S B Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
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Abstract
BACKGROUND AND OBJECTIVES Laparoscopic transcystic common bile duct exploration (LTCBDE) is a complex procedure requiring expertise in laparoscopic and choledochoscopic skills. The purpose of this study was to investigate the safety and feasibility of treating biliary calculi through laparoscopic transcystic exploration of the CBD via an ultrathin choledochoscope combined with dual-frequency laser lithotripsy. METHODS From August 2011 through September 2014, 89 patients at our hospital were treated for cholecystolithiasis with biliary calculi. Patients underwent laparoscopic cholecystectomy and exploration of the CBD via the cystic duct and the choledochoscope instrument channel. A dual-band, dual-pulse laser lithotripsy system was used to destroy the calculi. Two intermittent laser emissions (intensity, 0.12 J; pulse width 1.2 μs; and pulse frequency, 10 Hz) were applied during each contact with the calculi. The stones were washed out by water injection or removed by a stone-retrieval basket. RESULTS Biliary calculi were removed in 1 treatment in all 89 patients. No biliary tract injury or bile leakage was observed. Follow-up examination with type-B ultrasonography or magnetic resonance cholangiopancreatography 3 months after surgery revealed no instances of retained-calculi-related biliary tract stenosis. CONCLUSION The combined use of laparoscopic transcystic CBD exploration by ultrathin choledochoscopy and dual-frequency laser lithotripsy offers an accurate, convenient, safe, effective method of treating biliary calculi.
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Affiliation(s)
- Jun Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medicine University Beijing, China
| | - Lan Jin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medicine University Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medicine University Beijing, China
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Management of impacted common bile duct stones during a laparoscopic procedure: A Retrospective Cohort Study of 377 Consecutive Patients. Int J Surg 2016; 32:1-5. [PMID: 27321383 DOI: 10.1016/j.ijsu.2016.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/12/2016] [Accepted: 06/10/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION To explore the techniques for managing impacted common bile duct (CBD) stones during laparoscopic common bile duct exploration (LCBDE). METHODS We retrospectively analyzed 377 consecutive patients undergoing LCBDE from January 2008 to June 2015. Group 1 was defined as patients with impacted CBD stones. Group 2 included patients without impacted CBD stones. The outcomes of LCBDE were compared between the two groups. RESULTS There were 65 patients in Group 1 and 312 patients in Group 2. The incidence of jaundice, abnormal liver function tests, cholangitis and pancreatitis was higher in Group 1. Forty-one patients with small impacted CBD stones were managed using the tipless Nitinol basket. Seventeen patients with large impacted CBD stones and 7 patients with small impacted CBD stones underwent laser lithotripsy via choledochoscopy. None of the patients in Group 1 was converted to open procedures for impacted CBD stones. Operation duration was 13.6 min longer in Group 1 (133.2 min). Postoperative hospital stay was significantly longer in Group 1 (9.7 ± 2.5 d) than in Group 2 (6.3 ± 1.8 d). There was no difference in the overall postoperative complication rate, retained stone rate, and recurrence rate between the two groups. CONCLUSION Rational utilization of laser lithotripsy and an appropriate basket in LCBDE may avoid conversion to open procedures in patients with impacted CBD stones.
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Lei J, Wang J, Li Q, Wu P, Yuan R, Zhu H, Zou S, Shao J, Fang L. Laparoscopic Transcystic Common Bile Duct Exploration: T-Shaped Incision of Cystic Duct with FREDDY Laser Lithotripsy. J Laparoendosc Adv Surg Tech A 2016; 26:646-51. [PMID: 27139745 DOI: 10.1089/lap.2016.0004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Optimal laparoscopic techniques for management of gallstones concomitant with common bile duct (CBD) stones remain under debate. The aim of this study was to evaluate a novel approach to managing gallstones concomitant with large or impacted CBD stones through a modified laparoscopic transcystic CBD exploration (LTCBDE) with frequency-doubled double-pulse neodymium:YAG (FREDDY) laser lithotripsy. MATERIALS AND METHODS This retrospective review includes 32 consecutive patients with gallstones concomitant with large or impacted CBD stones who were offered LTCBDE with FREDDY laser lithotripsy between June 2012 and December 2014. Demographic, perioperative, and follow-up data were collected and analyzed retrospectively. RESULTS CBD stone clearance was achieved for all patients. There were 13 males and 19 females, among whom there were three patients with a history of abdominal surgery. The diameter of the CBD ranged from 10 to 20 (mean 15.1) mm, and the number of CBD stones ranged from 1 to 5. CBD stones ranged in diameter from 9 to 18 (mean 11.7) mm and 9 patients had stones that were impacted in the CBD. The mean operative time was 123 ± 18 minutes with a range of 72 to 155 minutes. The mean length of postoperative hospital stay was 5.3 (range 4-7) days. All patients recovered normally without morbidity or mortality. CONCLUSIONS The modified LTCBDE with a T-shaped incision of the cystic duct and FREDDY laser lithotripsy is a safe and effective means of managing gallstones concomitant with large or impacted CBD stones.
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Affiliation(s)
- Jun Lei
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Jun Wang
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Qiang Li
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Peng Wu
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Rongfa Yuan
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Hengqing Zhu
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Shubing Zou
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Jianghua Shao
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Lu Fang
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
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Tejera Hernández AA, Cabrera García ME, Navarro Medina P, García Plaza G, Larrea Olea FJ, Hernández Hernández JR. Hepatolithiasis. Surgical approach using endoscopic holmium laser for treatment. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:16-18. [PMID: 26831824 DOI: 10.1016/j.gastrohep.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/20/2015] [Accepted: 12/04/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Ana Alicia Tejera Hernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Mercedes Elisa Cabrera García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Patricio Navarro Medina
- Servicio de Urología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Gabriel García Plaza
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Francisco Javier Larrea Olea
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Juan Ramón Hernández Hernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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Prognostic Risk Factors Associated with Recurrence and Metastasis After Radical Resection in Patients with Hepatolithiasis Complicated by Intrahepatic Cholangiocarcinoma. Cell Biochem Biophys 2015; 73:455-460. [DOI: 10.1007/s12013-015-0665-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Zhang GW, Lin JH, Qian JP, Zhou J. Identification of risk factors for intraoperative hemobilia and its correlation with early postoperative complications in patients with hepatolithiasis. Am J Surg 2014; 209:260-7. [PMID: 25190546 DOI: 10.1016/j.amjsurg.2014.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/04/2014] [Accepted: 05/15/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study intends to determine the risk factor(s) for intraoperative hemobilia in patients with hepatolithiasis and examine whether the occurrence of intraoperative hemobilia influences the rate of early postoperative complications. METHODS A retrospective analysis of 867 eligible patients was performed. Patients were divided into 2 groups: group A (hemobilia, n = 76) and group B (nonhemobilia, n = 791). RESULTS The incidence of intraoperative hemobilia was 8.8% (76/867). Independent risk factors of intraoperative hemobilia for patients with hepatolithiasis were interval between surgery and latest attack of acute cholangitis less than or equal to 38.8 days; preoperative attack of acute severe cholangitis; and intrahepatic duct stricture. Group A had a higher incidence of early postoperative complications than group B. Shorter interval between surgery and latest attack of acute cholangitis correlated with intraoperative hemobilia and postoperative complications. CONCLUSION The severity and time of onset of preoperative acute cholangitis influence the risk of intraoperative hemobilia, which is positively correlated with early postoperative complications.
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Affiliation(s)
- Guo-wei Zhang
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China.
| | - Jian-hua Lin
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
| | - Jian-ping Qian
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, China
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Ma WJ, Zhou Y, Shrestha A, Mao H, Li FY, Cheng NS, Zhang W, Xu RH, Zhang YQ, Jiang T, Feng H, Li W, Han Q. Applying chemical bile duct embolization to achieve chemical hepatectomy in hepatolithiasis: a further experimental study. J Surg Res 2013; 187:113-21. [PMID: 24290428 DOI: 10.1016/j.jss.2013.10.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatolithiasis is the presence of calculi within the bile ducts of the liver. It represents a significant problem for hepatobiliary surgery because of its high recurrence rate and the associated risk for partial hepatectomy. This study was designed to explore the long-term efficacy of chemical biliary duct embolization (CBDE) to treat recurrent hepatolithiasis. MATERIALS AND METHODS A rabbit model of hepatolithiasis was established, and CBDE was achieved using oxybenzene and N-butyl-cyanoacrylate. The short-term (6 wk) and long-term (12 wk) efficacy of CBDE treatment was compared by observing the degree of atrophy, fibrosis, proliferation of collagen fibers, and apoptosis of hepatocytes and hepatic stellate cells in the embolized hepatic lobe. Biochemical measurement of β-glucuronidase was also evaluated to determine the effect of CBDE on stone formation. RESULTS Six weeks after CBDE, there was liver cell destruction, collagen accumulation, and bile duct proliferation only in the peripheral part of the target lobe. Twelve weeks after CBDE, "self-cut" chemical hepatectomy was achieved, as manifested by the destruction of almost all the hepatocytes in the target lobe, bile duct proliferation, and collagen fiber accumulation. The β-glucuronidase activity was markedly lower in the embolized lobe than in the nonembolized lobe. In contrast, bax, caspase-3, caspase-9, and α-smooth muscle actin expression was substantially higher in the embolized lobe than in the sham-operation group at 6 wk, but was lower at 12 wk. CONCLUSIONS CBDE is a potentially effective therapeutic approach for treating and preventing the recurrence of hepatolithiasis.
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Affiliation(s)
- Wen-jie Ma
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Anuj Shrestha
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hui Mao
- Department of Medicine, West China Hospital of Sichuan University, Chengdu, China.
| | - Fu-yu Li
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
| | - Nan-sheng Cheng
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Zhang
- Department of Medicine, The George Washington University, Washington, District of Columbia
| | - Rui-hua Xu
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yong-qiong Zhang
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ting Jiang
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Huan Feng
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wen Li
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Han
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
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