Benefits of Hepatic Resection in Recurrent Pyogenic Cholangitis among Bangladeshi Residents

Abstract

Introduction: Surgery is the corner stone treatment strategy for Recurrent pyogenic cholangitis (RPC) with stones and stricture. Sepsis is often a grave complication. Identification of source of sepsis to delineate the extent of disease and resection of unhealthy segment is the key to successful management. Method: This prospective study includes 523 cases of RPC surgically treated in a cohort of Bangladeshi patients, during January 2007 to January 2020. The study intended to analyze outcome of hepatic resection in RPC. Distortion of hepatic parenchymal architecture, stones, strictures and crowding of ducts were indications of hepatic resections with hepatolithotomy followed by T-tube or bilioenteric drainage with or without an access loop were treatment strategies. Result: Patients presented were between 20-77 yrs, 301 male (57.55%) and 222 were female (42.44%). 374 patients (71.51%) from south eastern part of Bangladesh. 29.06 % patients presented with Recurrent abdominal pain, Jaundice and fever. Isolated left duct stone found in 329 patients (62.09%), right duct stone in 33 patients (6.03%,) bilateral stones in 87 patients (14.91%) and both Intra-extrahepatic litihiasis in 74 patients (14.14%). Left Lateral Segmentectomy was the most common procedure in 387 cases. 184 patients required T-tube drainage, hepaticojejunostomy in 339 patients, Access loop in 34 patients (8.22%). Post-operative complications occured in 15% cases. Conclusion: Treatment strategy of RPC is tailored, depends on extent of disease and future remnant liver. Left ductal approach following left lateral segmentectomy ensure better approach to right ductal system for better ductal clearance to prevents recurrence.