Surgical treatment of hilar strictures in hepatolithiasis.

BACKGROUND/AIMS: The management of biliary strictures in hepatolithiasis, particularly at the hilus of the liver including the right and left hepatic bile ducts and their confluence, presents a challenge for surgeons because of their difficult access for surgical procedures and the life-threatening consequences, such as unrelenting cholangitis, recurrent biliary calculi, liver abscess and septicemia they can cause. This study analyzed the response of a group of patients with hilar strictures undergoing different surgical operations to assess methods dealing with this condition.

PATIENTS AND METHODS

A total of 545 patients with hepatolithiasis were admitted to our hospital. Among them, 256 patients were found to have an association of high bile duct strictures. These were classified into three types based on the sites of the stricture, and operated on with different combined surgical procedures in accordance with the type of the strictures. After the operation, further assessment was made during a follow-up period of between 12 months to 6 years.

RESULTS

Postoperative morbidity and mortality were 15.7% (40/256) and 1.2% (3/256), respectively. Before discharge from the hospital, all patients underwent imaging investigation, and the retained stone rate was 20.3% (53/256). Of the 70% of patients (179/256) who were available for further assessment, 85% had good treatment results, were asymptomatic and required no medical treatment. A few patients got a poor result when symptoms of cholangitis occurred several times a year and required hospitalization.

CONCLUSIONS

Successful treatment of hilar strictures in hepatolithiasis depends on the correct localization of the strictures, and complete exposure of the biliary tract proximal to strictures as well as the appropriate selection of the surgical procedures.