Intraoperative biliary exploration through the left hepatic duct orifice during left hepatectomy in patients with left-sided hepatolithiasis |
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Authors: | Shin Hwang Sung-Gyu Lee Myung-Hwan Kim Sung-Koo Lee Chul-Soo Ahn Ki-Hun Kim Young-Joo Lee |
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Institution: | (1) Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea;(2) Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea |
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Abstract: | Background and aims Left-sided hepatolithiasis often requires left hepatectomy and exploration of the common bile duct and right hepatic duct.
The aim of this study was to assess the feasibility of alternative method of bile duct exploration other than choledochotomy.
Materials and methods A prospective study involving 50 cases of left hepatectomy for left or bilateral intrahepatic stone was performed. Left hepatic
duct (LHD) orifice was used as primary access route for biliary exploration. Choledochotomy was performed only for large common
bile duct stones, variant bile duct anatomy, or intentional T-tube insertion for later removal of residual stones.
Results In 44 patients with left-sided hepatolithiasis, biliary exploration through LHD orifice was performed in 40 (90.9%); T-tube
choledochotomy was required in three (9.1%). There was neither residual stone nor major surgical complication except infection,
and recurrence occurred in one patient during mean follow-up of 32 months. On the other hand, T-tube choledochotomy was performed
in three of six patients with bilateral hepatolithiasis (50%). Three patients had residual stones, and two of them were treated
by cholangioscopy through the T-tube tract. Recurrence occurred in two patients.
Conclusion We think that intraoperative biliary exploration through LHD orifice in left-sided hepatolithiasis patients is an effective
approach simplifying the operation procedure by avoiding choledochotomy and subsequent T-tube insertion. |
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Keywords: | Hepatolithiasis Choledochotomy Left lobectomy |
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