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Management of intrahepatic stones with special reference to Roux‐en‐Y choledochojejunostomy: 1‐ to 15‐year follow‐up study
Author(s) -
Ho LuChang
Publication year - 1995
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/bf02349259
Subject(s) - medicine , surgery , intrahepatic bile ducts , bile duct , percutaneous
From December 1977 to August 1992, 186 patients with intrahepatic duct stones (IHDS) underwent extended choledocholithotomy followed by Roux‐en‐Y choledochojejunostomy, performed by the author. The male to female ratio was 80:106 and the age range was 10–73 years (mean 42.4 years); 53 liver resections (2 posterior segmentectomies, 50 lateral segmentectomies, 1 left lobectomy) and 21 Longmire's operations were also performed. A long‐term (1‐to 15‐year) follow‐up study revealed 154 patients (82.7%) to be symptom‐free and cured; there were 9 (4.8%) deaths, including 2 (1.0%) hospital deaths, and 23 (12.3%) recurrences. Most of the patients with recurrence (18/23, 78%) were successfully treated by non‐invasive procedures (16 patients by opening the proximal jejunal loop of the choledochojejunostomy, followed by choledochoscopy, and 2 patients by percutaneous transhepatic choledochoscopy; PTCS). One patient died of cholangiocarcinoma 3 months after PTCS. Stone clearance was achieved in 74% (17/23) of the patients with recurrence and all of them were symptom‐free. The author's finding is consistent with the conclusion that Roux‐en‐Y choledochojejunostomy is a safe and effective method for managing intrahepatic stones, even in patients with recurrence.