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Is Oddi sphincterotomy an indication for hepatolithiasis?
Xiaofeng Ling1, Zhi Xu, Lixin Wang
1Department of Surgery, Peking University Third Hospital, Beijing, 100191, People's Republic of China.
Insights
Neither conventional open surgical transduodenal sphincteroplasty nor endoscopic sphincterotomy effectively reduces recurrent cholangitis in hepatolithiasis patients. Long-term outcomes show no significant improvement in preventing severe cholangitis after these procedures.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Interventions
- Biliary Tract Diseases
Background:
- Hepatolithiasis management aims to decrease recurrent cholangitis.
- Sphincterotomy is a potential treatment for hepatolithiasis.
- Long-term outcomes of sphincterotomy for hepatolithiasis require evaluation.
Purpose of the Study:
- To determine the long-term efficacy of Oddi sphincterotomy in treating hepatolithiasis.
- To compare recurrent cholangitis rates before and after sphincterotomy procedures.
Main Methods:
- A cohort of 32 hepatolithiasis patients was analyzed.
- 15 patients underwent conventional open surgical transduodenal sphincteroplasty (COSTS).
- 17 patients underwent endoscopic sphincterotomy (EST).
- Recurrent cholangitis and acute cholangitis severe type (ACST) rates were compared pre- and post-treatment.
- Paired chi-squared test was used for statistical analysis.
Main Results:
- In the COSTS group, post-operative recurrent cholangitis remained high (86.7%) and ACST rates did not decrease significantly.
- In the EST group, post-procedure recurrent cholangitis (76.5%) and ACST rates showed no significant reduction.
- Neither COSTS nor EST demonstrated a significant decrease in cholangitis rates compared to pre-treatment levels.
Conclusions:
- Eradication of hepatobiliary lesions is crucial for hepatolithiasis management.
- Preserving the integrity of the Oddi sphincter is important.
- Neither COSTS nor EST is an effective method for reducing cholangitis in hepatolithiasis.
Background:
The purpose of treatment for hepatolithiasis is reducing recurrent cholangitis. This study was designed to determine the long-term outcome of Oddi sphincterotomy for hepatolithiasis.
Methods:
Thirty-two consecutive hepatolithiasis patients, including 15 cases that had undergone conventional open surgical transduodenal sphincteroplasty (COSTS) and 17 cases with endoscopic sphincterotomy (EST), were followed up for a long term. We compared the post-treatment rates of recurrent cholangitis and acute cholangitis severe type (ACST) with the ones of pretreatment in each group, respectively. Paired chi(2) test was used.
Results:
In the COSTS group, neither the post-operative rate of recurrent cholangitis (86.7%, 13/15 vs. 100%, 15/15) nor ACST (26.7%, 4/15 vs. 46.7%, 7/15) decreased (p > 0.05) compared with before the operation. In the EST group, the situation was the same: neither the rate of post-EST recurrent cholangitis (76.5%, 13/17 vs. 82.4%, 14/17) nor ACST (29.4%, 5/17 vs. 23.5%, 4/17) were reduced significantly (p > 0.05).
Conclusions:
Both eradication of hepatobiliary lesions and keeping Oddi sphincter intact should be emphasized in the management of hepatolithiasis. Neither COSTS nor EST is an effective method or can achieve the goal of reducing cholangitis for hepatolithiasis.