Abstract
Background:
Recurrent pyogenic cholangitis (RPC) is a common disease in Southeast Asia. Its classical presentation is repeated attacks of cholangitis with multiple recurrences of bile duct stones. The stones are commonly located in the left lateral segments (2 and 3) and therefore complete clearance is difficult to achieve by either endoscopic retrograde cholangiopancreatography or surgical exploration of the common bile duct. The definitive treatment usually involves resection of the stone-harboring segments. The recent advent in laparoscopic surgery has shown that hand-assisted laparoscopic segmentectomy is a safe and feasible, alternative. This study aimed to compare hand-assisted laparoscopic segmentectomy with open segmentectomy in patients with recurrent, RPC.
Methods:
This study retrospectively reviewed a prospectively maintained database of both open and laparoscopic treatments for RPC in a single center between 1994 and 2004. During this period, patients with RPC and left intrahepatic (segments 2 and 3) ductal stones not amendable to endoscopic treatment were recruited for analysis. Patients with concomitant gallbladder stones and common bile duct stones were offered left lateral segmentectomy with cholecystectomy and exploration of the common bile duct. Selected patients would have choledochoduodenostomy drainage during the same operation. The operations were performed via either the hand-assisted laparoscopic approach or the open approach using an ultrasonic surgical aspirator. The two cohorts were compared with respect to perioperative parameters to determine whether there would be any advantage in attempting hand-assisted laparoscopic segmentectomy.
Results:
During the study period from 1994 to 2004, 17 patients underwent left lateral segmentectomy for RPC. Of the 17 patients, 10 had hand-assisted laparoscopic resections, and 7 underwent open resections. All open resections were performed before 1999. Despite the small number of patients and potential type 2 error, there were no differences in age, sex distribution, number of cholangitic attacks, sessions of endoscopic retrograde cholangiopancreatography before surgery, or number of previous operation between the two groups. The median operating time was shorter in the open group (232.5 vs 150 min; p = 0.007), whereas the median blood loss was similar (350 vs 400 ml; p = 0.551). The median postoperative stay was 8 days for hand-assisted laparoscopic group versus 14 days for the open group. This difference was statistically significant (p = 0.019). There was one open conversion in the hand-assisted laparoscopic group because of intraoperative bleeding from the left hepatic vein. Postoperative complication rates were lower in hand-assisted laparoscopic group, but the difference was not statistically significant (20% vs 57%; p = 126). The intramuscular pethidine requirement again was less in hand-assisted laparoscopic group (0 vs 600 mg; p = 0.002). There was no operative mortality in either group of patients. No recurrent cholangitis was noted in either groups during the median follow-up period of more than 3 years.
Conclusion:
This study not only confirmed the feasibility of hand-assisted laparoscopic segmentectomy for recurrent pyogenic cholangitis, but also showed that this treatment approach is associated with less pain and shorter hospital stay. However, hand-assisted laparoscopic segmentectomy is a lengthier operation and technically more challenging. Nevertheless, the authors believe that with more experience and further improvement of ancillary technology, this procedure can become a standard treatment for recurrent pyogenic cholangitis in selected cases.
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References
Chen SS, Chou F, Eng H (1991) Intrahepatic cholangiocarcinoma in hepatolithiasis: a frequently overlooked disease J Surg Oncol 47: 131–135
Fan ST, Choi TK, Chan FL, et al (1990) Role of computed tomography in the management of recurrent pyogenic cholangitis Aust N Z J Surg 60:559–605
Fan ST, Lai ECS, Wong J (1993) Hepatic resection for hepatolithiasis Arch Surg 128: 1070–1074
Fan ST, Mok F, Zheng SS, Lai ECS, Lo CM, Wong J (1993) Appraisal of hepaticocutaneous jejunostomy in the management of hepatolithiasis Am J Surg 165: 332–335
Lai ECS, Mok FPT, Fan ST, et al (1992) Endoscopic biliary drainage for severe acute cholangitis N Engl J Med 326: 1582–1586
Lam SK, Wong KP, Chan PK, et al (1978) Recurrent pyogenic cholangitis: a study by endoscopic retrograde cholangiography Gastroenterology 74: 1196–1203
Nakayama F (1982) Intrahepatic calculi: a special problem in East Asia World J Surg 6:802–804
Tang CN, Li MKW (2003) Hand-assisted laparoscopic segmentectomy in recurrent pyogenic cholangitis Surg Endosc 17: 324–327
Tang CN, Li MKW (2002) Laparoscopic-assisted liver resection J Hepatobiliary Pancreat Surg 9: 105–110
Tang CN, Siu WT, Ha JPY, Li MKW (2003) Laparoscopic choledochoduodenostomy: an effective procedure for recurrent pyogenic cholangitis Surg Endosc 17:1590–1594
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Tang, C.N., Tai, C.K., Ha, J.P.Y. et al. Laparoscopy versus open left lateral segmentectomy for recurrent pyogenic cholangitis. Surg Endosc 19, 1232–1236 (2005). https://doi.org/10.1007/s00464-004-8184-7
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DOI: https://doi.org/10.1007/s00464-004-8184-7