Management of intrahepatic stones with special reference to Roux-en-Y choledochojejunostomy: 1- to 15-year follow-up study

Abstract

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.