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Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis

Abstract

To investigate the role of balloon dilatation in the management of complicated hepatolithiasis with intrahepatic biliary stricture, 57 consecutive patients who received 208 sessions of dilatation in addition to the usual treatment were analyzed. The strictures were located in the right intrahepatic ducts (84.2%), left intrahepatic ducts (12.3%), or both (3.5%). Dilatation began 3–4 weeks after surgery. The routes of dilatation included the matured T-tube tract (3 cases), percutaneous transhepatic biliary drainage tracts (42 cases), and both (12 cases). The immediate overall success rate of complete stone clearance increased significantly from 0% predilatation to 94.7% postdilatation. The main complications of dilatation therapy consisted of septicemia (10.5%), hemobilia (10.5%), and mild diarrhea (80%). Eight patients (14%) with long-segment strictures received 11 postdilatation biliary stentings. Complications were 1 patient with occlusion and 2 patients with “spontaneous” hemobilia. Severe multiple strictures and coexistent secondary biliary cirrhosis were the contributing factors to complications. During the follow-up of 3.4±1.2 years, recurrence of strictures was found in 4 patients. Two of them belonged to the stenting group. The cumulative probability of restricture was low: 4% at 2 years, 6% at 2.5 years, and 8% at 3 years. We conclude that in complicated cases of hepatolithiasis with intrahepatic biliary stricture, dilatation and stenting are good adjuvant therapies.

Résumé

Pour évaluer le rôle de la dilatation au cathéter dans le traitement des lithiases hépatiques compliquées en rapport avec une sténose des voies biliaires intra-hépatiques, les résultats de 57 patients ayant eu 208 séances de dilatation en plus du traitement habituel ont été analysés. La sténose était localisée à droite dans 84.2% des cas, à gauche dans 12.3%, et bilatérale dans 3.5%. On a commencé la dilatation 3–4 semaines après la chirurgie. La dilatation s'est effectuée par le trajet du drain de Kehr (3 cas), par le trajet du drainage percutané (42 cas), ou par les deux ensemble (12 cas). Le taux de succès immédiat d'extraction complète est passé de 0% avant la dilatation à 94.7% après la dilatation. Les complications principales de la dilatation étaient septicémie (10.5%), hémobilie (10.5%), et diarrhée modérée (80%). Huit patients (14%) avaient des sténoses longues qui nécessitaient la pose d'une prothèse après dilatation dans 11 cas. Dans un cas, la prothèse s'est exclue et 2 patients ont eu une hémobilie “spontanée.” L'existence de sténoses multiples sévères associées à une cirrhose biliaire secondaire étaient facteurs de complications. Pendant le suivi de 3.4±1.2 ans, 4 patients ont eu une récidive de leur sténose; 2 d'entre eux avaient eu une prothèse. La probabilité cumulative de re-sténose était basse: 4% à 2 ans, 6% à 2.5 ans, et 8% à 3 ans. Nous concluons que dans la lithiase associée à des sténoses intra-hépatiques, la dilatation et la pose d'une prothèse sont des thérapeutiques adjuvantes satisfaisantes.

Resumen

Con el objeto de definir el papel de la dilatación mediante balón intraluminal en el manejo de la hepatolitiasis complicada con estenosis biliar intrahepática, se analizaron 57 pacientes consecutivos sometidos a 208 sesiones de dilatación adicionales al tratamiento usual. Las estenosis aparecieron ubicadas en los canales intrahepáticos derechos (84.2%), en los canales intrahepáticos izquierdos (12.3%), y en ambos (3.5%). La dilatación fue iniciada 3–4 semanas después de la cirugía. Las rutas de acceso para la dilatación incluyeron el tracto maduro del tubo-en-T (3 casos), tractos de drenaje biliar percutáneo transhepático (42 casos), y ambos (12 casos). La tasa global de éxito inmediato en cuanto a remoción completa de los cálculos aumentó significativamente de 0% predilatación a 94.7% postdilatación. Las principales complicaciones de la terapia de dilatación fueron septicemia (10.5%), hemobilia (10.5%), y diarrea leve (80%). En 8 pacientes (14%) con estenosis largas se colocaron 11 prótesis intraluminales postdilatación; en un paciente se presentó oclusión y en 2 hemobilia “espontánea.” Estenosis múltiples severas y cirrosis secundaria coexistente fueron factores contribuyentes de las complicaciones. En el curso de un seguimiento de 3.4±1.2 años se encontró recurrencia de la estenosis en 4 pacientes. Dos de ellos correspondieron al grupo con prótesis intraluminales. La probabilidad acumulativa de reestenosis fue baja: 4% a 2 años, 6% a 2.5 años, y 8% a 3 años. Nuestra conclusión es que en casos complicados de hepatolitiasis con estenosis biliar intrahepática, la dilatación con implantación de prótesis intraluminales representan buenas modalidades terapéuticas adyuvantes.

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Correspondence to Kuo-Shyang Jeng M.D..

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Jeng, K., Yang, F., Ohta, I. et al. Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis. World J. Surg. 14, 587–592 (1990). https://doi.org/10.1007/BF01658796

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Keywords

  • Balloon Dilatation
  • Biliary Drainage
  • Percutaneous Transhepatic Biliary Drainage
  • Main Complication
  • Biliary Stentings