Surgical treatments for patients with recurrent bile duct stones and Oddis sphincter laxity

Zhou, Boxuan; Hu, Jinxiong; Zhong, Yi

doi:10.5582/irdr.2017.01053

Cited by 12 publications

(16 citation statements)

References 35 publications

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“…In addition, although a special surgical algorithm (including fibrocholedochoscopic extraction of stones via T tube tract, endoscopic extraction of stones, choledocholithotomy and T tube drainage, choledochojejunostomy, percutaneous transhepatic cholangioscopy, etc.) to treat patients with recurrent choledocholithiasis and SOL has been proposed (9), no evidence obtained to date provides strong support for this approach. Understanding the true roles of SOL in altering the bile duct microbiota and bile duct stone recurrence is important to guide the treatment of patients with SOL and choledocholithiasis.…”

Section: Introductionmentioning

confidence: 99%

Sphincter of Oddi laxity alters bile duct microbiota and contributes to the recurrence of choledocholithiasis

Zhang¹,

Ye²,

Su³

et al. 2020

Ann Transl Med

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Background: Choledocholithiasis is closely associated with bacterial infection and inflammation in the bile duct. Our previous studies showed that sphincter of Oddi laxity (SOL) significantly altered the bile microbiota and might contribute to the recurrence of biliary stones. However, the direct association among SOL, the bile microbiota, and choledocholithiasis recurrence is unclear.Methods: We prospectively recruited 202 patients with choledocholithiasis, and obtained bile samples from the common bile duct. We performed 16S ribosomal RNA gene analysis to characterize the bile microbiota and analyzed the risk factors for choledocholithiasis.Results: Distinct bile microbial communities were identified in patients with and without SOL, with a significantly larger abundance of Rhizobiaceae in patients with SOL. Patients with SOL had a higher risk of biliary stone recurrence, with a considerably shorter recurrence time. The abundance of Clostridium was significantly higher in patients with stone recurrence. SOL [P=0.024, hazard ratio (HR) =10.800, 95% confidence interval (CI): 1.377-84.701] was an independent risk factor of choledocholithiasis recurrence.Conclusions: Choledocholithiasis patients with and without SOL demonstrated significant differences in their microbial communities. SOL is a critical risk factor for the recurrence of choledocholithiasis after surgery. The presence of Clostridium may be potentially associated with the recurrence of SOL-induced choledocholithiasis.

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Section: Introductionmentioning

confidence: 99%

Sphincter of Oddi laxity alters bile duct microbiota and contributes to the recurrence of choledocholithiasis

Zhang¹,

Ye²,

Su³

et al. 2020

Ann Transl Med

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“…In descending infection, bacteriobilia is believed to occur via the portal venous system, while in ascending infection intestinal bacteria enter the biliary tract through the duodenal papilla [ 23 – 25 ]. Oddis sphincter dysfunction allows bacteria-containing intestinal fluid to reflux into the biliary tract [ 26 ]. In the current study, we observed that 75.0% of patients had a structural abnormality at the lower end of the common bile duct.…”

Section: Discussionmentioning

confidence: 99%

“…Controlling infection is an important part of the treatment of hepatolithiasis. Because structural and functional abnormalities of duodenal papillae cannot be repaired, choledochojejunostomy is the only treatment option to block bacterial infection [ 26 ]. Choledochojejunostomy can prevent intestinal bacteria from entering the biliary tract, and resolve cholestasis due to structural abnormalities in the Oddis sphincter.…”

Section: Discussionmentioning

confidence: 99%

“…Post-choledochojejunostomy biliary-enteric anastomosis stenosis is mainly caused by ischemia and hypoxia that can occur in the bile duct wall at the biliary-enteric anastomotic site [ 13 ]. During choledochojejunostomy, the blood vessels supplying the bile duct are severed, resulting in ischemia of the bile duct tissue [ 26 ]. When a biliary-enteric anastomosis is performed on bile duct tissue that has undergone ischemia/hypoxia, tissue contracture, fibrous tissue hyperplasia, and scar formation can occur in the bile duct wall tissue, eventually resulting in biliary-enteric anastomotic stenosis [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Resection of extrahepatic bile ducts with partial hepatectomy for treating intra- and extrahepatic hepatolithiasis

et al. 2021

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Background To evaluate the efficacy and safety of our new surgical procedures for primary intra- and extrahepatic hepatolithiasis. Hepatolithiasis is an intractable disease with frequent recurrences. Methods From 1996 to 2005, 142 patients with intrahepatic and/or extrahepatic hepatolithiasis treated with the conventional surgical methods were included as the control group, while 128 consecutive patients treated with new surgical methods from 2006 to 2015 were included as the observation group. The new surgical procedures included a comprehensive intraoperative exploration of the bile ducts, focusing on the structure and function of the hilar bile duct and duodenal papilla, exploration of the affected liver, and bile culture. Results The observation group had a significantly higher complete stone clearance rate than the control group (100% vs. 65.96%). The observation group had significantly lower incidences of cholangitis and bile duct stones, as well as a higher excellent and good long-term surgical efficacy rate (86.24% vs. 52.73%). Multivariate Cox analysis showed that the control group had a higher risk for fair + poor efficacy than the observation group (HR: 8.47). Conclusions Our new surgical procedures are safe and can provide a good long-term efficacy for treating primary hepatolithiasis intra- and extrahepatic hepatolithiasis.

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“…The incidence of CBD stone development is approximately 2%-5% after open and laparoscopic cholecystectomy 1 and 5%-15% after common bile duct exploration. 2 With the advance of laparoscopic techniques, laparoscopic common bile duct exploration (LCBDE) has been introduced for the treatment of CBD stone in patients with previous biliary surgery history. 3 T-tube drainage of CBD after laparoscopic choledochotomy is performed traditionally to prevent biliary complications including biliary leakage and stricture.…”

Section: Introductionmentioning

confidence: 99%

Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

Wan

Wang

et al. 2020

The American Surgeon™

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Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

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Surgical treatments for patients with recurrent bile duct stones and Oddis sphincter laxity

Cited by 12 publications

References 35 publications

Sphincter of Oddi laxity alters bile duct microbiota and contributes to the recurrence of choledocholithiasis

Sphincter of Oddi laxity alters bile duct microbiota and contributes to the recurrence of choledocholithiasis

Resection of extrahepatic bile ducts with partial hepatectomy for treating intra- and extrahepatic hepatolithiasis

Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

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