Xu Li1, Li Shi, Yu Wang, Fu-Zhou Tian. 1. Department of General Surgery, Chengdu Military General Hospital, Chengdu 610083, China.
Abstract
BACKGROUND: Roux-en-Y choledochojejunostomy is routinely performed in patients with regional hepatolithiasis. However, some of these patients, who have a normal gallbladder and normal Oddi's sphincter, are unnecessarily undergoing bilio-intestinal drainage. Alternatively, reconstruction can be achieved by subcutaneous tunnel and hepatocholangioplasty with the utilization of the gallbladder (STHG). This method is effective to potential endoscopic tunnel and intervention during follow-up, and prevention of reflux cholangitis as well as the disorders of the GI tract. METHODS: The middle and long-term complications of 46 patients who underwent STHG were analyzed. With B-ultrasonography and biochemical assay, the contraction and concentration function of the gallbladder were also studied. RESULTS: Follow-up showed that all patients survived with a relatively normal life. One patient experienced right epigastric pain, chills and fever because of a stone which impacted in the left hepatic bile duct. Another patient had cholangitis because of biliary ascariasis. The two patients were treated by endoscopic therapy within the subcutaneous gallbladder under local anesthesia. CONCLUSIONS: This operation not only keeps the normal physical functional of the gallbladder, Oddi's sphincter and gastrointestinal tract, but also prevents reflux cholangitis and the disorder of the digestive tract. Hence STHG is a novel operation dealing with regional hepatolithiasis.
BACKGROUND: Roux-en-Y choledochojejunostomy is routinely performed in patients with regional hepatolithiasis. However, some of these patients, who have a normal gallbladder and normal Oddi's sphincter, are unnecessarily undergoing bilio-intestinal drainage. Alternatively, reconstruction can be achieved by subcutaneous tunnel and hepatocholangioplasty with the utilization of the gallbladder (STHG). This method is effective to potential endoscopic tunnel and intervention during follow-up, and prevention of reflux cholangitis as well as the disorders of the GI tract. METHODS: The middle and long-term complications of 46 patients who underwent STHG were analyzed. With B-ultrasonography and biochemical assay, the contraction and concentration function of the gallbladder were also studied. RESULTS: Follow-up showed that all patients survived with a relatively normal life. One patient experienced right epigastric pain, chills and fever because of a stone which impacted in the left hepatic bile duct. Another patient had cholangitis because of biliary ascariasis. The two patients were treated by endoscopic therapy within the subcutaneous gallbladder under local anesthesia. CONCLUSIONS: This operation not only keeps the normal physical functional of the gallbladder, Oddi's sphincter and gastrointestinal tract, but also prevents reflux cholangitis and the disorder of the digestive tract. Hence STHG is a novel operation dealing with regional hepatolithiasis.