Surgical Management of Recurrence of Primary Intrahepatic Bile Duct Stones

Abstract

Background. The surgical treatment of primary intrahepatic bile duct stones is associated with high rates of postoperative complications, stone recurrence, and reoperation. This study aimed to report an 11-year experience in the management of postoperative recurrence of intrahepatic bile duct stones, analyze the causes of the reoperation, and establish appropriate surgical procedures. Materials and Methods. The records of 148 patients with postoperative recurrence of primary intrahepatic bile duct stones treated from January 2005 to December 2015 were retrospectively reviewed. Prior surgical treatment and postoperative data were analyzed to investigate possible causes of recurrence and reoperation. Results. All patients with a prior cholangiojejunostomy (n = 61) developed biliary stenosis (100%). Of the 86 patients without cholangiojejunostomy, 71 (82.56%) had abnormalities in the structure and function of the lower end of the common bile duct, and 86 had hilar and intrahepatic bile duct stenosis. Of all 148 patients, 136 (91.89%) had positive intraoperative bile cultures. Patients were treated with a modified surgical procedure, and the combined excellent and good rate of long-term outcomes reached 85.48% (106/124). The stone recurrence rate of the 124 patients decreased from 100% (124/124) of the prior operation to 5.65% (7/124) during the reoperation. Conclusions. The pathogenesis of primary intrahepatic bile duct stones is associated with biliary infection and intrahepatic bile duct cholestasis. According to the etiology and pathogenic mechanism, surgical procedures that improve long-term outcomes and reduce postoperative recurrence include bile duct exploration with stone extraction, partial hepatectomy, hilar ductoplasty, and Roux-en-Y hepaticojejunostomy.

Ultrasound-guided percutaneous transhepatic one-step biliary fistulation combined with rigid choledochoscopy for recurrent hepatolithiasis

“…RHL is prone to further exacerbate the bile duct obstruction if it is not treated in time, which may lead to cholangitis, liver abscess, and even liver failure [ 16 , 17 ]. Related reports show that 3.7–14.1% of HL eventually develop biliary cirrhosis and 3.3–21.2% develop HL-related intrahepatic cholangiocellular carcinoma [ 18 ]. In our study, preoperative comorbid hepatic tumours were excluded, and no hepatic tumours were detected in patients during a mean follow-up period of 23 months.…”

“…The treatment of RHL is currently still surgical, and the main treatment modalities include hepatectomy, PTCS, choledochojejunostomy, endoscopic lithotripsy, with the aim of removing stones, relieving stenosis, and patrolling drainage [ 19 , 20 ]. Among them, hepatectomy is considered the first choice for the treatment of HL, but in patients who have a wide distribution of stones, partial hepatectomy is limited, and it is often required to be combined with other surgical procedures [ 3 , 18 ]. Li performed hepatectomy combined with cholangioscopy for stone extraction in 56 patients with HL, stone clearance and recurrence rates were 92.9% and 13.5%, and 26.8% of patients experienced postoperative complications [ 21 ].…”

Outcomes of laparoscopic choledochotomy using cholangioscopy via percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis: A preliminary Vietnamese study

“…However, because the etiology and pathogenesis of HL and CL are not fully understood [ 3 ], patients’ outcomes are still far from satisfactory. Biliary stone may become a chronic disease associated with relatively high stone recurrence rates (up to 22%–50%), reoperation, and complications [ 4 - 6 ].…”