Extended Hepaticocholedochojejunostomy for Treatment of Intrahepatic Gallstones T. Tsunoda 1 , R. Tsuchiya 1 , N Harada 1 , R. Yoshino 1 , K. Yamamoto 1 1The Second Department of Surgery, Nagasaki University, School of Medicine pp.427-435
Published Date 1984/4/25
DOI https://doi.org/10.11477/mf.1403107004
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 From September 1969 to March 1983, there were 118 patients of intrahepatic stones who were treated surgically at the Second Department of Surgery, Nagasaki University Hospital. Thirteen patients of them were associated with malignant tumors of the biliary duct or stomach. The remaining 105 patients were divided into four types; type Ⅰ,5 patients in whom stenotic or dilated lesion of the biliary tract was absent; type Ⅱ,25 patients in whom stenotic lesion was absent or found only in the extrahepatic portion of the biliary duct; type Ⅲ,33 patients in whom stenotic lesions with solitary or multiple cystic dilatation were present in the left intrahepatic bile duct; type Ⅳ,42 patients in whom stenotic lesions with solitary or multiple cystic dilatation were present in the right or bilateral intrahepatic bile ducts.

 Type Ⅰ and Ⅱ may be called secondary intrahepatic stones, and type Ⅲ and Ⅳ may be called primary intrahepatic stones. Overall operative mortality was 3.8 percent. Eleven patients died in the follow-up period. The majority of the patients who died were in type Ⅳ cases with a long duration of illness before surgery, and they needed many operations for residual stones. The patients in type Ⅰ or Ⅱ were treated with choledocholithotomy, choledochoduodenostomy or choledochojejunostomy, while the patients in type ⅢI were treated with left hepatic resection and additional bilioenteric anastomosis. Type Ⅳ patients were treated by partial hepatic resection with bilioenteric anastomosis, including extended hepaticocholedochojejunostomy.

 Postoperative follow-up study revealed satisfactory results in 100% of the patients in type Ⅰ and 83% of the cases in type Ⅱ. The patients in type Ⅲ and Ⅳ had satisfactory results in 79% or 81% of the cases, respectively. The patients in type Ⅱ, Ⅲ and Ⅳ cases treated with choledochoduodenostomy or cholangiojejunostomy showed poor results. The residual stones in type Ⅳ patients were demonstrated postoperatively in 15 out of 26 (57.7%). The most excellent results (91%) were obtained in type Ⅳ by extended hepaticocholedochojejunostomy especially with hepatectomy. Ten patients treated with extended hepaticocholedochojejunostomy were readmitted for the further evaluation of postoperative status by ultrasonography (US) and computed tomography (CT). In 80% of these patients, US and CT examinations revealed absence or decrease of the residual stones.

 It is suggested that extended hepaticocholedochojejunostomy with partial hepatic resection is a reasonable procedure for primary intrahepatic stones of bilateral lobes of the liver.

Copyright © 1984, Igaku-Shoin Ltd. All rights reserved.


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