BACKGROUND AND AIMS: Left-sided hepatolithiasis often requires left hepatectomy and exploration of the common bile duct and right hepatic duct. The aim of this study was to assess the feasibility of alternative method of bile duct exploration other than choledochotomy. MATERIALS AND METHODS: A prospective study involving 50 cases of left hepatectomy for left or bilateral intrahepatic stone was performed. Left hepatic duct (LHD) orifice was used as primary access route for biliary exploration. Choledochotomy was performed only for large common bile duct stones, variant bile duct anatomy, or intentional T-tube insertion for later removal of residual stones. RESULTS: In 44 patients with left-sided hepatolithiasis, biliary exploration through LHD orifice was performed in 40 (90.9%); T-tube choledochotomy was required in three (9.1%). There was neither residual stone nor major surgical complication except infection, and recurrence occurred in one patient during mean follow-up of 32 months. On the other hand, T-tube choledochotomy was performed in three of six patients with bilateral hepatolithiasis (50%). Three patients had residual stones, and two of them were treated by cholangioscopy through the T-tube tract. Recurrence occurred in two patients. CONCLUSION: We think that intraoperative biliary exploration through LHD orifice in left-sided hepatolithiasis patients is an effective approach simplifying the operation procedure by avoiding choledochotomy and subsequent T-tube insertion.
BACKGROUND AND AIMS: Left-sided hepatolithiasis often requires left hepatectomy and exploration of the common bile duct and right hepatic duct. The aim of this study was to assess the feasibility of alternative method of bile duct exploration other than choledochotomy. MATERIALS AND METHODS: A prospective study involving 50 cases of left hepatectomy for left or bilateral intrahepatic stone was performed. Left hepatic duct (LHD) orifice was used as primary access route for biliary exploration. Choledochotomy was performed only for large common bile duct stones, variant bile duct anatomy, or intentional T-tube insertion for later removal of residual stones. RESULTS: In 44 patients with left-sided hepatolithiasis, biliary exploration through LHD orifice was performed in 40 (90.9%); T-tube choledochotomy was required in three (9.1%). There was neither residual stone nor major surgical complication except infection, and recurrence occurred in one patient during mean follow-up of 32 months. On the other hand, T-tube choledochotomy was performed in three of six patients with bilateral hepatolithiasis (50%). Three patients had residual stones, and two of them were treated by cholangioscopy through the T-tube tract. Recurrence occurred in two patients. CONCLUSION: We think that intraoperative biliary exploration through LHD orifice in left-sided hepatolithiasis patients is an effective approach simplifying the operation procedure by avoiding choledochotomy and subsequent T-tube insertion.
Authors: Young Jun Kim; Joon Koo Han; Jun Yong Jeong; Kyoung Ho Lee; Se Hyung Kim; Young Il Kim; Jeong Min Lee; Byung Ihn Choi; Youn-Chan Park; Sun-Whe Kim Journal: Eur J Radiol Date: 2005-05 Impact factor: 3.528
Authors: D H Park; M H Kim; S S Lee; S K Lee; K P Kim; J M Han; S Y Kim; M H Song; D W Seo; A Y Kim; T K Kim; Y I Min Journal: Endoscopy Date: 2004-11 Impact factor: 10.093
Authors: J Shoda; K Oda; H Suzuki; Y Sugiyama; K Ito; D E Cohen; L Feng; J Kamiya; Y Nimura; H Miyazaki; M Kano; Y Matsuzaki; N Tanaka Journal: Hepatology Date: 2001-05 Impact factor: 17.425