Abstract
Background/Purpose
We reviewed the selective use of hand-assisted laparoscopic segmentectomy (HALS) and laparoscopic choledochoduodenostomy (LCD) in the management of recurrent pyogenic cholangitis (RPC).
Methods
We carried out a retrospective review of a prospectively maintained database of laparoscopic treatment of RPC during the period 1995 to 2004. The perioperative data were analyzed.
Results
There were 33 laparoscopic procedures performed in 30 patients with RPC during the period 1995–2004. There were 23 female and 7 male patients, with a mean age of 63.2 ± 14.9 years (range, 29–92 years). All these patients had a history of repeated attacks of cholangitis, and multiple sessions of endoscopic lithotripsy or operative retrieval had previously been attempted. Of these 33 procedures, there were 23 LCDs and 10 HALS. Three patients underwent simultaneous LCD and HALS in the same operation. The mean operative time was 172 ± 63.5 min (range, 75–290 min) and there were three open conversions (10%), due to (1) intraoperative bleeding from the left hepatic vein, (2) lost broken tip of ultrasonic dissector, and (3) significant bleeding during choledochotomy, respectively. Average hospital stay was 11.4 ± 11.1 days (range, 5–60 days). Eight complications (26.6%) were encountered, which included four bile leaks, three wound infections, and one intraabdominal collection. Complete stone clearance was achieved in all but 1 patient (rate, 96.6%), in whom the residual stones were extracted through a postoperative combined endoscopic and percutaneous approach. Long-term results were satisfactory, and only one stone recurrence was detected, upon a mean follow-up of 34.7 months (range, 1–107 months).
Conclusions
Both LCD and HALS are safe, feasible, and effective treatments for patients with RPC.
Similar content being viewed by others
References
F Nakayama (1982) ArticleTitleIntrahepatic calculi: a special problem in East Asia World J Surg 6 802–804 Occurrence Handle1:STN:280:BiyD1MrkvFc%3D Occurrence Handle7180014
ST Fan ECS Lai J Wong (1993) ArticleTitleHepatic resection for hepatolithiasis Arch Surg 128 1070–1074 Occurrence Handle1:STN:280:ByyA2sflsVY%3D Occurrence Handle8368927
CN Tang MKW Li (2003) ArticleTitleHand-assisted laparoscopic segmentectomy in recurrent pyogenic cholangitis Surg Endosc 17 324–327 Occurrence Handle1:CAS:528:DC%2BD2cXovFSru7Y%3D Occurrence Handle12384763
CN Tang MKW Li (2002) ArticleTitleLaparoscopic-assisted liver resection J Hepatobiliary Pancreat Surg 9 105–110 Occurrence Handle12021904
SS Chen F Chou H Eng (1991) ArticleTitleIntrahepatic cholangiocarcinoma in hepatolithiasis: a frequently overlooked disease J Surg Oncol 47 131–135 Occurrence Handle1648151
P Parrilla P Ramirez F Sanchez Bueno JM Perez MF Candel MS Muelas (1991) ArticleTitleLong term results of choledochoduodenostomy in the treatment of choledocholithiasis: assessment of 225 cases Br J Surg 78 470–472 Occurrence Handle1:STN:280:By6B3srgt1U%3D Occurrence Handle2032108
Y Panis PL Fagniez Td Brisse F Lacaine H Levard JM Hay (1993) ArticleTitleLong term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis Surg Gynecol Obstet 177 33–37 Occurrence Handle1:STN:280:ByyA3M%2Fmt1U%3D Occurrence Handle8322146
CN Tang WT Siu JPY Ha MKW Li (2003) ArticleTitleLaparoscopic choledochoduodenostomy: an effective procedure for recurrent pyogenic cholangitis Surg Endosc 17 1590–1594 Occurrence Handle1:STN:280:DC%2BD3sngs1Ohtg%3D%3D Occurrence Handle12874693
SK Lam KP Wong PK Chan H Ngan GB Ong (1978) ArticleTitleRecurrent pyogenic cholangitis: a study by endoscopic retrograde cholangiography Gastroenterology 74 1196–1203 Occurrence Handle1:STN:280:CSeC28botFc%3D Occurrence Handle648809
ST Fan TK Choi FL Chan (1990) ArticleTitleRole of computed tomography in the management of recurrent pyogenic cholangitis Aust NZ J Surg 60 559–605
ECS Lai FPT Mok ST Fan (1992) ArticleTitleEndoscopic biliary drainage for severe acute cholangitis N Engl J Med 326 1582–1586 Occurrence Handle1:STN:280:By2B287mslM%3D Occurrence Handle1584258
ST Fan F Mok SS Zheng ECS Lai CM Lo J Wong (1993) ArticleTitleAppraisal of hepaticocutaneous jejunostomy in the management of hepatolithiasis Am J Surg 165 332–335 Occurrence Handle1:STN:280:ByyC1M7ivVE%3D Occurrence Handle8447537
GA Degenshein (1974) ArticleTitleCholedochoduodenostomy: an 18-year study of 175 consecutive cases Surgery 76 319–324 Occurrence Handle1:STN:280:CSuB2sfgvVI%3D Occurrence Handle4602098
P Parrilla P Ramirez F Sanchez Bueno JM Perez MF Candel MS Muelas (1991) ArticleTitleLong term results of choledochoduodenostomy in the treatment of choledocholithiasis: assessment of 225 cases Br J Surg 78 470–472 Occurrence Handle1:STN:280:By6B3srgt1U%3D Occurrence Handle2032108
JL Madden JY Chun S Kandalaft M Parekn (1970) ArticleTitleCholedochoduodenostomy: an unjustly maligned surgical procedure? Am J Surg 119 45–54 Occurrence Handle1:STN:280:CS%2BD1cfoslQ%3D Occurrence Handle5411668
JL Madden (1970) ArticleTitlePrimary common bile duct stones World J Surg 2 465–471
Y Panis PL Fagniez TD Brisse F Lacaine H Levard JM Hay (1993) ArticleTitleLong term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis Surg Gynecol Obstet 177 33–37 Occurrence Handle1:STN:280:ByyA3M%2Fmt1U%3D Occurrence Handle8322146
Author information
Authors and Affiliations
About this article
Cite this article
Tang, CN., Tai, CK., Siu, WT. et al. Laparoscopic treatment of recurrent pyogenic cholangitis. J Hepatobiliary Pancreat Surg 12, 243–248 (2005). https://doi.org/10.1007/s00534-004-0961-0
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00534-004-0961-0