Surgical treatment of recurrent pyogenic cholangitis.

OBJECTIVE

To examine the evolving operative strategies in the treatment of recurrent pyogenic cholangitis (RPC).

DESIGN

Case series of patients with RPC treated surgically at the Los Angeles County-University of Southern California Medical Center between 1980 and 1994.

SETTING

Public teaching hospital.

PATIENTS

Twenty patients with RPC were studied. The clinical diagnosis of RPC was made in patients with a syndrome of chronic intermittent attacks of biliary sepsis associated with intrahepatic biliary strictures and intrahepatic stones.

MAIN OUTCOME MEASURE

The need for repeated biliary intervention after surgical treatment of RPC.

RESULTS

Four patients had a hepatic lobectomy without biliary enteric bypass. One patient had an uneventful course. Three patients had postoperative biliary sepsis, and one of these patients died. A hepaticojejunostomy without a cutaneous stoma was performed in eight patients. Five (63%) of these eight required repeated operation for biliary sepsis 1 to 4 years after surgery. In eight patients, a Roux-en-Y hepaticojejunostomy was performed after attempted clearance of intrahepatic stones with construction of a temporary cutaneous stoma. Postoperatively, these eight patients had 16 transstomal endoscopic cholangiograms (mean follow-up, 10 months). Stones proximal to intrahepatic strictures were identified in seven endoscopic sessions in five of these patients (63%). The stones were removed, and the strictures were endoscopically dilated. None required repeated biliary operation.

CONCLUSION

RPC is a progressive, lifelong disease. Construction of a hepaticojejunostomy with a cutaneous stoma allows future therapeutic intervention without the need for repeated surgery.