Hand-assisted laparoscopic segmentectomy in recurrent pyogenic cholangitis

Recurrent pyogenic cholangitis (RPC) is a prevalent disease in Southeast Asia and presents a unique challenge to both gastroenterologist and hepatobiliary surgeon. Despite rapid development in endoscopic instrumentation and skill maturation, it is still difficult to clear those pigmented stones lodged in the intrahepatic ducts. The alternative approach to stones through the percutaneous transhepatic route can offer access for repeated ductal dilatation and lithotripsy. However, recurrence is still commonly seen. Resection of the atrophic stone-harboring segment has proven to be an effective treatment option associated with the lowest recurrence rate. Compared to the other technique, it is the only treatment that can potentially offer a cure. The complication rate is higher because of existing bacterial colonization and access trauma. With the accumulation of laparoscopic experience and improved instrumentation, laparoscopic liver resection is demonstrated to be safe and feasible for either benign or malignant conditions. This article reviews a single-center experience of hand-assisted laparoscopic segmentectomy (HALS) in patients with RPC.