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Published on: September 13, 2022
Long-term results of hepaticojejunostomy for hepatolithiasis
1First Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Insights
Hepaticojejunostomy for hepatolithiasis (bile duct stones) leads to high rates of recurrent stones and cholangitis (bile duct inflammation). This surgical approach remains controversial due to these significant postoperative complications.
Area of Science:
- Hepatobiliary Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Hepaticojejunostomy is effective for benign biliary-enteric bypass.
- Hepatolithiasis presents challenges with residual/recurrent stones and cholangitis post-surgery.
Purpose of the Study:
- To evaluate the long-term outcomes of hepaticojejunostomy in hepatolithiasis patients.
- To assess the incidence of postoperative cholangitis and overall results.
Main Methods:
- Retrospective review of 159 hepatolithiasis patients over 23 years.
- Analysis of surgical approaches: hepatectomy (94 patients) and liver-preserving surgery (65 patients).
- Specific focus on 72 patients who underwent hepaticojejunostomy.
Main Results:
- A 31.4% rate of residual or recurrent stones was observed after complete removal.
- 30.6% of patients with hepaticojejunostomy developed cholangitis.
- This complication rate was significantly higher compared to patients without biliary-enteric anastomosis.
Conclusions:
- Hepaticojejunostomy for hepatolithiasis is associated with a high incidence of cholangitis.
- The use of this procedure in cases with potential residual stones or intrahepatic lesions is debatable.
- Further research is needed to clarify the role of hepaticojejunostomy in managing complex hepatolithiasis.
Abstract:
The results of a hepaticojejunostomy as a biliary-enteric bypass for benign disease are usually excellent. On the other hand, hepatolithiasis features a high rate of residual and recurrent stones with cholangitis after surgery. This study aims to evaluate the long-term results of a hepaticojejunostomy for hepatolithiasis regarding both the degree of the occurrence of postoperative cholangitis and the outcome. The clinical records of 159 patients with hepatolithiasis who underwent surgical treatment over a 23-year period were also retrospectively reviewed. Ninety-four of 159 patients underwent a hepatecetomy and 65 patients were subjected to liver-preserving surgery by means of intra- and postoperative endoscopic lithotripsy. In addition 72 patients underwent a hepaticojejunostomy. The rate of residual or recurrent stones was 31.4 per cent after complete stone removal. Twenty-two (30.6%) of the 72 patients developed some kind of cholangitis. This rate was significantly higher than that (three of 87 patients) of the non-biliary-enteric anastomosis group regarding the occurrence of biliary complications. We conclude that the use of a hepaticojejunostomy for patients with possible residual stones or intrahepatic bile duct lesions remains controversial.
