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Surgical treatment of hilar strictures in hepatolithiasis
1Department of Hepatobiliary Surgery, Sun Yat-Sen University of Medical Sciences, Guangzhou, China. jeffrey@gzsums.edu.cn
Insights
Managing hilar biliary strictures in hepatolithiasis is challenging. This study found that accurate localization and appropriate surgical procedures lead to good outcomes in most patients with these complex liver conditions.
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Surgical oncology
Background:
- Hilar biliary strictures in hepatolithiasis pose significant surgical challenges due to difficult access and severe complications like cholangitis and liver abscesses.
- Management requires careful consideration of anatomical complexity and potential life-threatening consequences.
Purpose of the Study:
- To analyze the outcomes of patients with hilar strictures associated with hepatolithiasis who underwent various surgical interventions.
- To assess the effectiveness of different surgical approaches in managing these complex biliary conditions.
Main Methods:
- A retrospective analysis of 545 patients with hepatolithiasis, focusing on 256 patients with high bile duct strictures.
- Patients were classified into three types based on stricture location and treated with tailored surgical procedures.
- Follow-up assessments were conducted for 12 months to 6 years post-operation.
Main Results:
- Postoperative morbidity was 15.7% and mortality was 1.2%.
- The retained stone rate was 20.3% before hospital discharge.
- Among patients available for follow-up, 85% achieved good treatment results, remaining asymptomatic.
Conclusions:
- Successful management of hilar strictures in hepatolithiasis hinges on precise stricture localization.
- Complete exposure of the biliary tract proximal to the stricture is crucial.
- Appropriate selection of surgical procedures is paramount for favorable patient outcomes.
Background/Aims:
The management of biliary strictures in hepatolithiasis, particularly at the hilus of the liver including the right and left hepatic bile ducts and their confluence, presents a challenge for surgeons because of their difficult access for surgical procedures and the life-threatening consequences, such as unrelenting cholangitis, recurrent biliary calculi, liver abscess and septicemia they can cause. This study analyzed the response of a group of patients with hilar strictures undergoing different surgical operations to assess methods dealing with this condition.
Patients And Methods:
A total of 545 patients with hepatolithiasis were admitted to our hospital. Among them, 256 patients were found to have an association of high bile duct strictures. These were classified into three types based on the sites of the stricture, and operated on with different combined surgical procedures in accordance with the type of the strictures. After the operation, further assessment was made during a follow-up period of between 12 months to 6 years.
Results:
Postoperative morbidity and mortality were 15.7% (40/256) and 1.2% (3/256), respectively. Before discharge from the hospital, all patients underwent imaging investigation, and the retained stone rate was 20.3% (53/256). Of the 70% of patients (179/256) who were available for further assessment, 85% had good treatment results, were asymptomatic and required no medical treatment. A few patients got a poor result when symptoms of cholangitis occurred several times a year and required hospitalization.
Conclusions:
Successful treatment of hilar strictures in hepatolithiasis depends on the correct localization of the strictures, and complete exposure of the biliary tract proximal to strictures as well as the appropriate selection of the surgical procedures.