Results of Roux-en-Y hepatico-jejunostomy with modified FagKan-Chou Tsoung techniques in the treating of residual and recurrent stones after operations

Study on 175 patients underwent Roux-en-Y hepatico-jejunostomy on the Y ansa with subcutaneous intestinal extremities because of intrahepatic and extrahepatic stones. There was no postoperative death. Short-term outcomes were good in 64.57%, moderate in 27.2%, and poor in 8.00%. Long-term outcomes were good in 71.95%, moderate in 20.12%, and poor in 7.92%. Treatment for main stone by drain lavage was good in 25.22%, moderate in 28.00% and bad in 45.94%. Treatment for residual stone under image intensifier through intestinal head was good in 31.13%, moderate in 68.17% and bad in 0%. These findings showed that this technique is good in treating postoperative residual and recurrent stones

The Factors Influencing the Treatment Results of Residual & Recurrent Biliary Stones / 한국간담췌외과학회지

BACKGROUND/AIMS: There has been a lot of controversy about the treatment methods in the management of residual & recurrent biliary stones. So we performed the study to clarify the important factors in choosing the treatment modality of the residual & recurrent biliary stones. METHODS: 154 patients who were diagnosed as residual or recurrent biliary stone between January 1995 and August 2000 were divided into 4 groups according to their first re- treatment methods (surgery, stone removal via T-tube, PTBD*, ESTP**) and analyzed the results of these treatments to determine what is the significant factor affecting the prognoses. RESULTS: The necessity of the second re-treatment for residual & recurrent stones was affected by the complete- ness of stone removal only, and no other factors affected it in view of multivariate analysis. The rate of residual & recurrent stones among the patients who have had the first operation in our department was 6.7%. Furthermore the clearance rate of residual & recurrent stones was relatively high value (82.2%), as a result of multidisciplinary treatments. CONCLUSION: Thus, as long as the residual stones can be removed completely, any treatment modality can be applied to these patients. We don't have to insist on surgery.

Comparison of Stone Metabolic Risk Factors in Recurrent Stone Formers according to Sex and Age / 대한비뇨기과학회지

PURPOSE: In order to compare stone metabolic risk factors in recurrent stone formers, we researched lithogenic factors according to sex and age. MATERIALS AND METHODS: We performed stone metabolic studies on recurrent stone formers (77 men, 33 women) and grouped them according to age; under 40 (n=38), from 40 to 59 (n=56) and over 60 (n=16). We evaluated excretion rate differences of lithogenic and inhibitory constituents such as volume, sodium, uric acid, calcium, oxalate, and citrate from 24-hour urine samples, and calcium, sodium, uric acid, phosphate, potassium, and chloride from serum samples. We analyzed the incidence of stone metabolic risk factors between the age groups and the sexes. RESULTS: The most common detectable risk factor in all groups of recurrent stone formers was hypocitraturia. This finding was more remarkable in males aged under 60. The incidence of hypocitraturia was higher in males and in the younger group, whereas hypercalciuria was more frequent in the elder group. CONCLUSIONS: The most important cause of urolithiasis was hypocitraturia in recurrent stone formers, and this was apparent in males aged under 60.

Treatment of intra- and extra- hepatic duct recurrent stones through the subcutaneous jejunal loop / 中国微创外科杂志

Objective To evaluate the significance of the treatment of intra- and extra- hepatic recurrent stones through the subcutaneous jejunal loop. Methods The authors respectively analyzed 24 cases of intra- or extra- hepatic recurrent stones and/or acute cholangitis treated through the subcutaneous jejunal loop from January 1989 to January 2003. Results Of the 24 cases, 10 cases (18 times) of acute cholangitis received drainage through the subcutaneous jejunal loop and their symptoms relieved (18/18); 14 cases (17 times) of recurrent intra- and extra- hepatic stones received selective drainage placement through the subcutaneous jejunal loop. The extra- or intra- hepatic stones were removed under choledochoscope through the subcutaneous jejunal loop, the stone clearance rate being 79.2% (19/24). Conclusions It is a convenient, minimally invasive, and effective method to treat intra- and extra- hepatic recurrent stones through the subcutaneous jejunal loop.

Non-Operative Management in Residual and Recurrent Bile Duct Stones

BACKGROUND: Residual and recurrent bile duct stones after biliary surgery cause many difficult problems. and reoperation on biliary tract has limitation due to its high morbidity and mortality. In recent years, various non-operative modalities for management in residual and recurrent stone have been developed. METHODS: We analyzed 69 cases of residual and recurrent bile duct stones which were managed with non-operative modalities at the Department of surgery, Dae Dong Hospital from Jan. 1994 to Dec. 1997, and evaluated the efficacy of these modalities. RESULTS: Female exceeded male with a ratio 1.76:1. and the peak incidence of age group was 6th decade. The most common diagnostic procedure was T-tube cholangiography (53.6%). Interval between previous operation and second procedure for residual or recurrent stones was within 6 months in most cases (82%). Cholecystectomy with T-tube choledochostomy was performed most frequently in previous operation. Residual and recurrent stones were found only at common bile duct in 34 cases (49.3%) most commonly. Common bile duct stones were managed most frequently with endoscopic sphincterotomy (39.5%), but the complete removal rate was heighest in choledochoscopic stone removal (100%). Complete removal rate of intrahepatic duct stone was heighest with interventional radiologic stone removal as well as choledochoscopic stone removal (43.6%), but average number of session was smaller in choledochoscopic stone removal (2.5) than interventional radiologic stone removal (3.5). Associated complication with non-operative management modalities were very low, except three cases of hepaticocutaneous jejunostomy. The latter required reoperation due to continuous bile fistula in two cases, and long jejunal loop in one case. CONCLUSIONS: Choledochoscopic stone removal is most effective method in the management of residual and recurrent bile duct stones.

Clinical Characteristics of Hypercalciuric Patients with Urinary Stone / 대한비뇨기과학회지

Hypercalciuria is the most important risk factor in stone formation, occuring in about 50% of patients with calcium containing stone. Also, it is thought that hypercalciuria is a heterogeneous disorder. We studied 408 hypercalciuria patients with urinary stone for the evaluation of clinical characteristics of hypercalciuric over eleven years from 1986 to 1996. Hyperuricosuria was found 26.3% in male and 10.8% in female, respectively. Incidence of hyperuricosuria in hypercalciuric patients with stone was significantly higher than that of patients with urinary stone. The frequency of recurrent stone was 43.1% (100/232) in male, 27.8% (49/176) in female. It was also significantly higher than that of patients with urinary stone, but there was no difference of urinary calcium between recurrence group and single episode group in hypercalciurics. As causes hypercalciuria, hypercalcemia was found in 36 patients, primary hyperparathyroidism in 17, immobilization syndrome in 8, hyperthyroidism in 4 and long term use of steroids in 1, repectively. As a result of oral calcium loading test, absorptive and renal leak type were found 6 patients (14.6%), respectively, resorptive type in 6 (14.6%) and 22 patients (53.7%) were not classified. Based on our experience, we also confirmed that idiopathic hypercalciuria was the heterogeneous sorder. High incidence of hyperuricosuria in urinary stone patients with hypercalciuria might be related with high intake of animal protein. Hypercalciuria was closely related with recurrence of stone but the degree of hypercalciuria was not related with its recurrence. Classification of idiopathic hypercalciuria by oral calcium loading test was available in half the cases.