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. 2015 Dec 7;21(45):12865-72.
doi: 10.3748/wjg.v21.i45.12865.

Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma for hepatolithiasis

Yu-Gui Lian  1 , Wei-Tao Zhang  1 , Zhi Xu  1 , Xiao-Feng Ling  1 , Li-Xin Wang  1 , Chun-Sheng Hou  1 , Gang Wang  1 , Long Cui  1 , Xiao-Si Zhou  1
Affiliations

Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma for hepatolithiasis

Yu-Gui Lian et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the long-term outcomes of Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS) and risk factors for recurrence in hepatolithiasis.

Methods: From March 1993 to December 2012, 202 consecutive patients with hepatolithiasis underwent OSPCHS at our department. The Oddi sphincter preserved procedure consisted of common hepatic duct exploration, stone extraction, hilar bile duct plasty, establishment of subcutaneous stoma to the bile duct. Patients with recurrent stones can undergo stone extraction and/or biliary drainage via the subcutaneous stoma which can be incised under local anesthesia. The long-term results were reviewed. Cox regression model was employed to analyze the risk factors for stone recurrence.

Results: Ninety-seven (48.0%) OSPCHS patients underwent hepatic resection concomitantly. The rate of surgical complications was 10.4%. There was no perioperative death. The immediate stone clearance rate was 72.8%. Postoperative cholangioscopic lithotomy raised the clearance rate to 97.0%. With a median follow-up period of 78.5 mo (range: 2-233 mo), 24.8% of patients had recurrent stones, 2.5% had late development of cholangiocarcinoma, and the mortality rate was 5.4%. Removal of recurrent stones and/or drainage of inflammatory bile via subcutaneous stoma were conducted in 44 (21.8%) patients. The clearance rate of recurrent stones was 84.0% after subsequent choledochoscopic lithotripsy via subcutaneous stoma. Cox regression analysis showed that residual stone was an independent prognostic factor for stone recurrence.

Conclusion: In selected patients with hepatolithiasis, OSPCHS achieves excellent long-term outcomes, and residual stone is an independent prognostic factor for stone recurrence.

Keywords: Hepatectomy; Hepaticoplasty; Hepatolithiasis; Sphincter of Oddi; Stone recurrence.

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Figures

Figure 1
Figure 1
Connecting the opened neighboring bile ducts to form a “hepatobiliary basin” (A); Obtaining a 12-15 cm free jejunum segment with a vascular pedicle (B); Performing a side-to-end anastomosis between the distal end of the free jejunum segment and the “hepatobiliary basin” (C); and Embedment in the skin after the closure of the free jejunum segment at its proximal end (D).
Figure 2
Figure 2
Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma in which the free jejunum segment served as the subcutaneous stoma (A) or in which the gallbladder served as the subcutaneous stoma (B). AW: Abdominal wall.
Figure 3
Figure 3
Cumulative stone recurrence curves of the residual group (n = 55) and non-residual group (n = 147) (log-rank test, P = 0.001).
See this image and copyright information in PMC

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