Complicated Hepatolithiasis Research Articles

Hepatolithiasis: A Retrospective Analysis of Surgical Management Options in a Tertiary Care Centre in Southern India.

Introduction: Hepatolithiasis (HL) is the presence of stones in the bile ducts proximal to the confluence of the hepatic ducts. This study aims to analyse the case presentations of HL in a tertiary care centre in South India and define the role of hepatic resection in these cases and their outcomes.Methods: Retrospective data of all patients operated on for HL from 2012 to 2021 were analysed with regard to clinical parameters, biochemical parameters, and different types of surgical management. Descriptive data analyses were done.Results: A total of 42 patients underwent surgical treatment for HL between 2012 and 2021 in our institution. Of the patients, 64% were females. A total of 50% of patients were affected by bilateral HL. Of the patients, 95% had abdominal pain, 57% had a fever, and 29% presented with jaundice. A total of 38% of patients had a history of previous biliary surgery. Atrophy was present in 38% of cases. Choledochoduodenostomy was performed in 26%, and hepatic resection with bilio-enteric anastomosis was done in 36% of patients. Endoluminal access loop was done in 21%. Hepaticojejunostomy alone was done in 14%. On follow-up visits (mean: 61.5 months), 60% of patients were asymptomatic with no recurrence. There was nil 30-day postoperative mortality.Conclusion: The treatment options for HL were based on the extent of liver involvement. The bilio-enteric anastomosis was done after the clearance of stones for uncomplicated HL. Complicated HL may need liver resection with hepaticojejunostomy, with an endoluminal access loop for a good outcome.

The value of three-dimensional visualization techniques in hepatectomy for complicated hepatolithiasis: A propensity score matching study

ObjectiveThe present study aimed to investigate the safety, feasibility, and efficacy of three-dimensional visualization technique (3DVT)-guided hepatectomy in the treatment of complicated hepatolithiasis. MethodsThe clinical and follow-up data of 279 patients with complicated hepatolithiasis were retrospectively analyzed. The patients were divided into a 3DVT group (group A, 66 cases) and a non-3DVT group (group B, 213 cases). After baseline data were balanced using propensity score matching (PSM), the clinical characteristics and follow-up data of the two groups were observed. ResultsAfter 1:1 PSM, 58 patients in each group were successfully matched with each other. When the groups were compared, the surgical duration (p = 0.033) and intraoperative blood loss (p = 0.002) of group A were lower than those of group B. The immediate stone clearance rate (91.4% vs. 75.9%, p = 0.024) and quality of life outcome (p = 0.034) of group A were significantly higher than those of group B. Logistic regression analysis showed that history of two or more biliary tract operations (odds ratio [OR] = 6.544, 95% confidence interval [CI] = 1.193–35.890, p = 0.031), bilateral stone distribution (OR = 4.198, 95% CI = 1.186–14.854, p = 0.026), and Geng grade III or IV (OR = 12.262, 95% CI = 2.224–67.617, p = 0.004) were independent risk factors for poor outcomes in patients with complicated hepatolithiasis. ConclusionCompared to conventional imaging examinations, 3DVT can be used to guide and achieve accurate preoperative diagnosis of complicated hepatolithiasis and has good safety, feasibility, and efficacy.

Correlation Among Psychological Resilience, Social Support, and Coping Style in Patients With Complicated Hepatolithiasis.

Objectives: To investigate the correlation between psychological resilience, social support, and coping styles in patients with complicated hepatolithiasis.Methods: The objective sampling method was used in this study to select a total of 156 patients with complicated hepatolithiasis in a Third-class Grade A hospital in Changsha, Hunan Province from January to December 2019. Self-designed general data questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Social Support Rating Scale (SSRS), and the Simplified Coping Style Questionnaire (SCSQ) were used to conduct a questionnaire investigation. Spearman correlation analysis was used to analyze the correlation between psychological resilience, social support, and coping styles in patients with complicated hepatolithiasis.Results: Both the total score of psychological resilience (45.79 ± 16.28) and social support (35.71 ± 9.92) of patients with complicated hepatolithiasis were significantly lower than those of the domestic norm. The total score of psychological resilience of patients with complicated hepatolithiasis was positively correlated with the total score of social support (r = 0.570, p < 0.01). The total score of psychological resilience and its three dimensions were positively correlated with the positive coping (r = 0.682, 0.673, 0.663, 0.535, p < 0.01)and negatively correlated with negative coping (r = −0.240, −0.207, −0.221, −0.286, p < 0.01).Conclusions: This study indicated that strengthening social support and improving the coping style of patients with complicated hepatolithiasis are helpful to improve their psychological resilience, which provided theory basis and reference for further intervention measures to improve social support system and coping styles.

Digital single-operator cholangioscopy-guided electronic hydraulic lithotripsy through an intraductal covered self-expandable metallic stent for complicated hepatolithiasis.

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The difficulties and surgical decision analysis of laparoscopic technique in treating complicated hepatolithiasis

Objective: To explore the difficulties and surgical decision of laparoscopic technique in patients with complicated hepatolithiasis. Methods: The clinical data of 13 patients with complicated hepatolithiasis who underwent laparoscopic hepatectomy at Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College from December 2019 to December 2020 were collected. There were 3 males and 10 females with average age of 50.8 years (range: 14 to 67 years). All patients had upper abdominal pain and a history of cholecystectomy, 4 of them had fever.Seven cases underwent laparoscopic left hemihepatectomy+bile duct exploration, 2 cases underwent laparoscopic right hemihepatectomy+bile duct exploration, 2 cases underwent laparoscopic quadrate hepatectomy (liver 4B+Part 5)+hilar cholangioplasty+bile duct exploration, 2 cases underwent laparoscopic quadrate lobe resection (liver 4B+Part 5)+cholangioplasty+cholangiojejunostomy. All patients were re-examined with abdominal ultrasound and choledochoscope 3 months after operation. Results: The median operation time was 5.2 hours (range: 3.6-6.5 hours), blood loss was 278 ml (range: 120-580 ml). During the operation, 1 case had duodenal bulb injury, and the defect area was about 1.0 cm × 1.2 cm. After timely detection, the defect area was carefully evaluated and trimmed. Absorbable suture was used to suture duodenal bulb, and gastrojejunostomy was performed after repair. One case had small intestinal serosa injury, which was intermittently sutured and embedded with absorbable suture. All the patients recovered smoothly without death. Three months after the operation, 12 patients completed abdominal ultrasound and T-tube sinus choledochoscopy. Residual stones were found in 3 patients, stones were removed in 2 patients by T-tube sinus choledochoscopy 3 months after the operation, 1 patient was still in the recovery period (within 3 months after surgery). No residual stones were found in the remaining 10 patients. Conclusion: The three key laparoscopic techniques in operation of complex hepatolithiasis: adhesiolysis and porta hepatis exposure, laparoscopic hepatectomy, and laparoscopic choledochojejunostomy are very important.

Application of Laparoscopic Technique in the Treatment of Hepatolithiasis

Hepatolithiasis is commonly encountered in Southeastern and East Asian countries, and its incidence is increasing in Western countries. For symptomatic hepatolithiasis or asymptomatic hepatolithiasis with signs of liver atrophy or malignancy, surgical intervention is needed, especially when peroral cholangioscopy and percutaneous transhepatic cholangioscopic lithotomy are not suitable or fail to be performed. Currently, laparoscopic surgery is gradually replacing traditional open surgery and becoming a better option. Various types of laparoscopic surgeries, including laparoscopic hepatectomy, laparoscopic biliary exploration through the common bile duct or the hepatic duct stump, and robotic-assisted laparoscopic surgery, have been developed for the treatment of simple hepatolithiasis, hepatolithiasis concomitant with choledocholithiasis, recurrent hepatolithiasis, and complicated hepatolithiasis. The related clinical experience is gradually accumulating. In this review, the laparoscopic applications and their advantages will be summarized. In most cases, the laparoscopic technique could provide the advantages of less trauma, reduced blood loss, and faster postoperative recovery.

The ultrasonic navigation technique in percutaneous transhepatic one-step biliary fistulation with rigid cholangioscopic lithotripsy for complicated hepatolithiasis

Objective To study the efficacy and safety of percutaneous transhepatic one-step biliary fistulation (PTOBF) with rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis under the ultrasonic navigation technique. Methods In this retrospective study, PTOBF lithotripsy surgery was performed in 94 patients with hepatolithiasis under general anesthesia with tracheal intubation, and with percutaneous transhepatic puncture of targeted bile duct under ultrasonic navigation in The First Affiliated Hospital of Guangzhou Medical University. Biliary expanders were used along a guidewire to expand the sinus gradually until 14Fr to establish a fistulous channel. Lithotripsy was then performed through the channel by rigid cholangioscopy. The operation-related data were collected and analyzed, including puncture and fistula establishment success ratio, complication rate, intraoperative blood loss, residual and recurrence hepatolithiasis rates. Results 94 patients (total 122 patient-times) underwent PTOBF lithotripsy. There was no perioperative mortality. The overall puncture success rate was 100%, and the fistula/puncture rate was 97.5% (119/122). In 118 patients success was achieved in 2 time (96.7%). The complication rate was 9.6% (9/94). The average intraoperation blood loss were (24.9±21.3)ml. The residual calculus rate after therapy was 13.8%(13/94). All patients were followed-up for a period that ranged between 18 and 30 months. The recurrence rate was 14.9%(14/94). Conclusions Ultrasonic navigation technique plays an important role in bile duct puncture, sinus expansion and rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis. PTOBF lithotripsy is a safe and effective procedure, which provides a new way in mini-invasive treatment for hepatolithiasis. It is worth generalizing. Key words: Ultrasound; Navigation; Percutaneous transhepatic puncture; Hepatolithiasis; Rigid cholangioscope

Anatomical hepatectomy combined with intraoperative choledochoscopy in treatment of complicated hepatolithiasis

Objective To study the clinical outcomes of anatomical hepatectomy combined with intraoperative choledochoscopy in treatment of complicated hepatolithiasis. Methods The clinical data of 176 patients with complicated hepatolithiasis who underwent operation at the Department of General Surgery of No.960 Hospital of PLA from May 2005 to July 2015 were analyzed retrospectively. The data included general data, clinical manifestations, types of stones, operative methods, postoperative complications and follow-up. Results There was no perioperative death. The postoperative complications which occurred in 31 patients (17.6%) included lung infection, intra-abdominal infection, bile leakage, and liver failure. Eighteen patients (10.2%) were found to have residual stones. After a follow-up which ranged from 1 to 3 years, 152 patients (94.4%) had good clinical outcomes. Recurrent stones were found in 12 patients (7.5%). Conclusion Anatomical hepatectomy combined with intraoperative choledochoscopy improved operative outcomes in patients with complicated hepatolithiasis and decreased residual stone and recurrence rates. Key words: Hepatolithiasis; Anatomical hepatectomy; Choledochoscope

Efficacy and safety of laparoscopy and open choledochal exploration in the treatment of complicated hepatolithiasis

Objective To study the efficacy and safety of laparoscopy and open choledochal exploration in the treatment of complicated hepatolithiasis. Methods From March 2014 to March 2017, 150 cases of complicated hepatolithiasis who were treated in Heji Hospital Affiliated to Changzhi Medical College were selected.The patients were divided into observation group and control group according to random number table, with 75 cases in each group.The control group was treated with conventional open abdominal common bile duct exploration, and the observation group was treated by laparoscopic choledochal exploration.The levels of surgical indicators, the incidence of complications, the recurrence rate, the bilirubin level before operation and 1 month after operation, and the quality of life before operation and 6 months after operation were compared between the two groups. Results The operative time, intraoperative blood loss, gastrointestinal recovery time and hospitalization time in the observation group were (154.23±20.47)min, (59.12±8.92)mL, (19.65±3.48)h, (11.48±2.48)d, respectively, which were significantly lower than those in the control group [(217.59±30.59)min, (87.24±10.17)mL, (27.87±6.12)h, (16.51±4.28)d] (t=14.908, 18.002, 10.112, 8.806, all P<0.05). The levels of total bilirubin, direct bilirubin and indirect bilirubin in the observation group at 1 month after operation were (14.38±3.69)μmol/L, (3.39±1.17)μmol/L, (11.45±3.02)μmol/L, which were significantly lower than those in the control group [(28.43±4.31)μmol/L, (6.31±2.08)μmol/L, (21.05±4.87)μmol/L] (t=21.445, 10.596, 14.508, all P<0.05). The incidence rate of complications and recurrence rate of the observation group at 6 months after operation were 2.67% and 0.00%, respectively, which were lower than 14.67% and 10.67% of the control group (χ2=6.822, 8.451, all P<0.05). The scores of social activities, energy, physical activity and sleep mood in the observation group at 6 months after operation were (4.72±0.85)points, (13.25±1.21)points, (3.81±0.51)points, (6.52±2.44)points, respectively, which were higher than those in the control group [(2.65±0.61)points, (8.09±0.68)points, (1.95±0.52)points, (3.98±2.38)points] (t=10.513, 11.605, 12.604, 6.454, all P<0.05). Conclusion Laparoscopic choledochal exploration is effective in the treatment of complicated hepatolithiasis, and it can improve the level of bilirubin and improve the quality of life, the safety is good. Key words: Cholecystolithiasis; Laparoscopy; Bilirubin; Comparative Effectiveness Research

Intrahepatic bile duct exploration lithotomy is a useful adjunctive hepatectomy method for bilateral primary hepatolithiasis: an eight-year experience at a single centre

BackgroundTo evaluate the perioperative and long-term results of intrahepatic bile duct exploration lithotomy (IHBDIL) combined with hepatectomy for patients with complicated bilateral primary hepatolithiasis.MethodsA study was conducted involving 56 patients with complicated bilateral primary hepatolithiasis who underwent IHBDIL combined with hepatectomy at our hospital from January 2006 to December 2014. The perioperative and long-term outcomes that were retrospectively analysed included the stone clearance rate, operative morbidity and mortality, and stone recurrence rate. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded.ResultsIn all 56 patients, hepatic duct stones were located in the bilateral IHBD. The surgical method was IHBDIL combined with hepatectomy. Postoperative complications occurred in 15 patients (26.8%), 14 patients responded to conservative management, and there was 1 case of postoperative mortality because of hepatic failure. The overall initial success rate of stone clearance was 85.7%, and the final clearance rate was 92.9% following postoperative choledochoscopic lithotripsy. The stone recurrence rate was 13.5%, and the occurrence of postoperative cholangitis was 10.9% during the follow-up period.ConclusionIHBDIL combined with hepatectomy is a safe, effective, and promising treatment for patients with complicated bilateral primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for complicated bilateral primary hepatolithiasis.

Hepatico-jejuno-duodenal access loop – a modified biliary reconstruction technique for facilitated endoscopic access to biliary tree following surgery for hepatolithiasis

Aims: Management of hepatolithiasis is complicated by residual and recurrent disease, and endoscopic access to biliary tree in such patients enables therapeutic interventions thereby avoiding the morbidity associated with relaparotomy. In this study we assess a modified biliary reconstruction in the form of hepaticojejuno- duodenal access loop (HJDA) with regard to the feasibility of endoscopic access to intrahepatic ducts with follow-up. Methods: From August 2011 till December 2016, all patients treated for hepatolithiasis with bilateral disease, nondilated extrahepatic biliary system or extensive intrahepatic strictures underwent HJDA. After completion of hepaticojejunostomy (HJ), the free end of the Roux loop was anastomosed to the first part of duodenum in a side to side fashion. In the fourth week postoperatively, endoscopy with conventional forward viewing endoscope was performed to explore the possibility of accessing the biliary system. Results: Endoscopic access to the intrahepatic bile ducts through the HJDA was possible in all the patients and mean time taken to access the HJ was 3.5 minutes (2-7 minutes). There were no complications pertinent to construction of the HJDA. One patient had bile leak from HJ, which settled with conservative management and surgical site infection was seen in four. We did not have any mortality in our series. During the follow up, three of our patients (30%) subsequently presented with cholangitis at a mean period of 22 months and were successfully managed with endoscopic procedures alone. One patient required balloon dilatation of the HJ stricture, while the other two were managed by endoscopic removal of calculi. Overall, five endoscopic procedures were required in three patients with recurrent cholangitis in the follow up period with rate of 1.67 procedures per patient. Conclusion: HJDA is a modified biliary reconstruction technique which facilitates endoscopic access to the biliary system for removal of recurrent/residual intrahepatic stones. It is therefore recommended in patients with complicated hepatolithiasis like bilateral disease, recurrence, multiple intrahepatic strictures and for those in whom future endoscopic access to biliary tree is deemed necessary.

Robotic-assisted laparoscopic surgery for complex hepatolithiasis: a propensity score matching analysis.

The indication for laparoscopic treatment of hepatolithiasis is early-stage regional hepatolithiasis. Open surgery (OS) is the traditional treatment for complex hepatolithiasis. Robotic-assisted laparoscopic surgery (RLS) overcomes the limitations of the traditional laparoscopic approach in terms of the visual field, instruments, and operational flexibility. RLS is thus theoretically indicated for the treatment of complicated hepatolithiasis. This study aimed to evaluate the safety, efficacy, and feasibility of RLS for the treatment of complicated hepatolithiasis. From October 2010 to August 2017, 26 consecutive patients who underwent RLS and 287 consecutive patients who underwent OS for the treatment of complicated hepatolithiasis at our center were included in this study. We performed a propensity score matching (PSM) analysis between patients who underwent RLS and patients who underwent OS at a ratio of 1:2. Twenty-six patients were included in the RLS group, and 52 patients were included in the OS group. The groups exhibited no differences with respect to age, sex, location of stones, liver function, history of previous surgery, or Child-Pugh classification. There were no differences in the postoperative complication rates (46.2% vs. 63.5%, p = 0.145), intraoperative stone clearance rates (96.2% vs. 90.4%, p = 1.000), or final stone clearance rates (100% vs. 98.1%, p = 0.652) between the two groups. The RLS group had less blood loss (315.38 ± 237.81 vs. 542.88 ± 518.70ml, p = 0.037), a lower transfusion rate (15.4% vs. 46.2%, p = 0.008), shorter oral intake times (3.50 ± 1.30 vs. 5.88 ± 4.00days, p = 0.004), and shorter postoperative hospital stays (13.54 ± 6.54 vs. 17.81 ± 7.49days, p = 0.016) than the OS group. At a median follow-up of 48months (range 7-90months), there were no differences in stone recurrence rate (3.8% vs. 13.5%, p = 0.356) or recurrent cholangitis rate (3.8% vs. 3.8%, p = 1.000) between RLS and OS patients. RLS for complicated hepatolithiasis is safe and feasible with advantages over OS in terms of intraoperative blood loss, transfusion rate, duration of hospital stays, and postoperative recovery.

Effectiveness of hepatic parenchyma lithotomy of hepatolithiasis: A single-center experience.

To investigate the clinical significance of hepatic parenchyma incision by lithotomy near the second hepatic portal area for the treatment of complex hepatolithiasis.A retrospective study was conducted with 35 patients who had complicated hepatolithiasis in our hospital from January 2008 to December 2013, who underwent hepatic parenchyma incision by lithotomy near the second hepatic portal area. The perioperative and long-term outcomes included the stone clearance rate, operative morbidity and mortality, and the stone recurrence rate. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded from the study.All patients with hepatic duct stones were mainly located at S2, S4, and S8 regions. Surgical methods included were hepatic parenchyma incision by lithotomy near the second hepatic portal area, or by combined partial hepatectomy. The mean follow-up period was 51 months. One patient died during hospitalization. The surgical morbidity was 17.6%, stone clearance rate was 88.2%, and final clearance rate was 94.1% followed by postoperative choledochoscopic lithotripsy. The stone recurrence rate was 15.6% and the occurrence of postoperative cholangitis was 11.8% during the follow-up period.Hepatic parenchyma incision by lithotomy near the second hepatic portal area is safe with satisfactory short and long-term outcome results for complicated hepatolithiasis.

Application of hepatic segment resection combined with rigid choledochoscope in the treatment of complex hepatolithiasis guided by three-dimensional visualization technology

To study the value of hepatic segment resection combined with rigid choledochoscope by the three-dimensional (3D) visualization technology in the diagnosis and treatment of complex hepatolithiasis. Enhance computed tomography (CT) data of 46 patients with complex hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from July 2010 to June 2014 were collected.All of the CT data were imported into the medical image three-dimensional visualization system (MI-3DVS) for 3D reconstruction and individual 3D types. The optimal scope of liver resection and the remnant liver volume were determined according to the individualized liver segments which were made via the distribution and variation of hepatic vein and portal vein, the distribution of bile duct stones and stricture of the bile duct, which provided guidance for intraoperative hepatic lobectomy and rigid choledochoscope for the remnant calculus lithotripsy. Outcomes of individual 3D types: 10 cases of type I, 11 cases of IIa, 23 cases of IIb, 2 cases of IIc, 19 cases coexisted with history of biliary surgery. The variation of hepatic artery was appeared 6 cases. The variation of portal vein was appeared 8 cases. The remaining liver volume for virtual hepatic lobectomy controlled more than 50%. Eighteen cases underwent left lateral hepatectomy, 8 cases underwent left liver resection, 8 cases underwent right posterior lobe of liver resection, 4 cases underwent the right hepatic resection, 4 cases underwent IV segment liver resection, 2 cases underwent right anterior lobe of liver resection, 2 cases underwent left lateral hepatectomy combined with right posterior lobe of liver resection, 26 cases underwent targeting treatment of rapid choledochoscope and preumatic lithotripsy. The actual surgical procedure was consistent with the preoperative surgical planning. There was no postoperative residual liver ischemia,congestion, liver failure occurred in this study. The intraoperative calculus clearance rate was 91.3% (42/46) because 4 cases of postoperatively residual calculi were not suitable for one stage management due to suppurative cholangitis but removed calculus successfully with rigid choledochoscope through T tube fistula. Hepatic segment resection combined with rigid choledochoscope under the guidance of three-dimensional visualization technology achieves accurate preoperative diagnosis and higher complete stone clearance rate of complicated hepatolithiasis.

Curative effect of surgical treatment in complicated hepatolithiasis

Curative effect of surgical treatment in complicated hepatolithiasis

Anatomical polysegmentectomy with reservation of segments I and IV for the treatment of complicated hepatolithiasis

Anatomical hepatic segmentectomy is the treatment of choice for hepatolithiasis. However, in consideration of the volume of residual liver and the liver function, anatomical polysegmentectomy of the bilateral lobes for hepatolithiasis is restricted. Protection of the portal pedicles to the segments preserved and avoidance of ischemia/reperfusion injury to the residual liver parenchyma are critical steps during the operation.A female patient with hepatolithiasis and had a surgical history of choledocholithiasis removal and T-tube drainage received ana tomic polysegmentectomy with segments Ⅰ and Ⅳ preservation at the General Hospital of Kunming Medical College. During the operation, Portal pedicles to the segments Ⅰ , Ⅱ, right lobe,and segments Ⅱ and Ⅲ were isolated prior to liver parenchyma transection. Portal pedicles to segments Ⅰ and Ⅳ were protected under direct visualization. Hepatoduodenal ligament occlusion was not applied during liver parenchyma transaction. Segments Ⅱ- Ⅲ and Ⅴ-Ⅷ were anatomically resected, and segments Ⅰ ,Ⅳ were preserved with satisfactory vascularization. The patient recovered uneventfully and was discharged 14 days after the operation. Key words: Hepatolithiasis; Anatomical liver resection; Portal pedicle

Management of Complicated Recurrent or Residual Hepatolithiasis

As the patterns of gallstone disease have changed, those with recurrent or residual hepatolithiasis (the so-called complicated hepatoliththiasis) are becoming more and more problematic. How to treat them properly is a new challenge. Contrast cholangiography as well as computed tomography or magnetic resonance cholangiography is necessary to delineate the location of stones, duct strictures, and possible coexisting malignancy preceding surgical or other biliary interventions. Resection of the involved segment or lobe of the liver is a safe and effective treatment for localized hepatolithiasis. Cholangioscopic lithotomy, either intraoperative, postoperative, or a percutaneous minimally invasive procedure without reoperation is important in stone eradication. Chemical biliary duct embolization to prevent stone recurrence has recently been reported. The antagonist of the epidermal growth factor receptor might suppress proliferative cholangitis in animal studies. To obtain a good long term outcome, it is important to keep in mind the possibility of coexisting intrahepatic cholangiocarcinoma, either before, during, or after treatment of complex hepatolithiasis. For complicated hepatolithiasis, a systematic approach with multimodal treatment by a cooperative team is recommended.

Surgical treatment of complicated hepatolithiasis using the ultrasound-guided fiberoptic choledochoscope

The residual stones of postsurgical intrahepatic calculi have been among the most difficult problems in hepatobiliary surgery. Intraoperative ultrasound can clearly display the morphology of intrahepatic bile ducts and the distribution of calculi as well as the position of the choledochoscope and the calculus extraction instruments. Therefore, intraoperative ultrasound can guide the choledochoscope and its auxiliary equipment for calculus extraction. It is necessary to evaluate the effectiveness and safety of surgeries using an ultrasound-guided fiberoptic choledochoscope for the treatment of complicated hepatolithiasis. The 56 cases in group A were selected from patients who had complicated hepatolithiasis treated with calculus extraction therapy using an ultrasound-guided fiberoptic choledochoscope in the authors' hospital between January 2006 and June 2009. The 63 cases of complicated hepatolithiasis in group B were chosen from patients treated with calculus extraction surgeries using a fiberoptic choledochoscope without the guidance of ultrasound from September 2001 through December 2005. Transabdominal ultrasound, T-tube cholangiography, and computed tomography (CT) examination were performed on day 15 after the surgery to compare the complete stone clearance rate, the residual stone rate, and the incidence rate of postoperative complications between groups A and B. The intrahepatic calculi were completely removed in 53 group A cases. The complete stone clearance rate was 94.6%, and the residual stone clearance rate was 5.4%. In group B, 51 cases had complete stone removal, for a stone clearance rate of 81% and a residual stone rate of 19%. The difference in the residual stone rates between the two groups is statistically significant (p=0.025). No hemobilia, biliary perforation, or other complications were observed in either group. Use of the intraoperative ultrasound-guided fiberoptic choledochoscope in the treatment of complicated hepatolithiasis can significantly reduce the residual stone rate of intrahepatic biliary calculi and significantly improve the treatment effect of hepatolithiasis.

Individualized treatment of complicated hepatolithiasis in 146 cases

Objective To explore the feasibility of individualized treatment for complicated hepatolithiasis. Methods The clinical data of patients with complicated hepatolithiasis treated in our hospital with different approaches in the past 4 years were retrospectively analyzed. Results The curative rate of the disease could be promoted by preoperative careful formulation of individualized regimen, perioperative performance of different approaches and postoperative conduction of different comprehensive treatments according to the actual illness conditions. Conclusion As the complicated hepatolithiasis is complex and there is no unified curing method, the important measures to impove curative rate is making detailed individualized treatment plan for every case. Key words: Bile duct calculi Individualized treatment

Liver Resection for Complicated Hepatolithiasis—Reply

Liver Resection for Complicated Hepatolithiasis—Reply