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Extended hepatico choledocho jejunostomy for treatment of intra hepatic gall stones

, : Extended hepatico choledocho jejunostomy for treatment of intra hepatic gall stones. Stomach & Intestine (Tokyo) 19(4): 427-436

Out of 118 patients with intrahepatic stones who were treated surgically, 13 had associated malignant tumors of the biliary duct or stomach. The remaining 105 patients were divided into 4 types: type I, 5 patients in whom stenotic or dilated lesion of the biliary tract was absent; type II, 25 patients in whom stenotic lesion was absent or found only in the extrahepatic portion of the biliary duct; type III, 33 patients in whom stenotic lesions with solitary or multiple cystic dilatation were present in the left intrahepatic bile duct and type IV, 42 patients in whom stenotic lesions with solitary or multiple cystic dilatation were present in the right or bilateral intrahepatic bile ducts. Type I and II may be called secondary intrahepatic stones, and type III and IV may be called primary intrahepatic stones. Overall operative mortality was 3.8%. Eleven patients died during the follow-up period. The majority of the patients who died were type IV cases with a long duration of illness before surgery, and they needed many operations for residual stones. The patients in type I or II were treated with choledocholithotomy, choledochoduodenostomy or choledochojejunostomy, while the patients in type III were treated with left hepatic resection and additional bilioenteric anastomosis. Type IV patients were treated by partial hepatic resection with bilioenteric anastomosis, including extended hepaticocholedochojejunostomy. Postoperative follow-up study revealed satisfactory results in 100% of the patients in type I and 83% of the cases in type II. The patients in type III and IV had satisfactory results in 79% or 81% of the cases, respectively. The patients in type II, III and IV cases treated with choledochoduodenostomy or cholangiojejunostomy showed poor results. The residual stones in type IV patients were demonstrated postoperatively in 15 out of 26 (57.7%). The most excellent results (91%) were obtained in type IV by extended hepaticocholedochojejunostomy especially with hepatectomy. Ten patients treated with extended hepaticocholedochojejunostomy were readmitted for the further evaluation of postoperative status by ultrasonography (US) and computed tomography (CT). In 80% of these patients, US and CT examinations revealed absence or decrease of the residual stones. Extended hepaticocholedochojejunostomy with partial hepatic resection is suggested a reasonable procedure for primary intrahepatic stones of the bilateral lobes of the liver.

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