Subcutaneous Tunnel and Hepatocholangioplasty Using the Gallbladder for Hepatolithiasis / 中国微创外科杂志

ABSTRACT

Objective To assess the efficacy of subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG) in the treatment of hepatolithiasis. Methods A retrospective analysis was done on 43 patients with hepatolithiasis who underwent STHG between June 2001 and May 2008. The strictured bile duct at the hilus was opened after removing the stones or cutting the damaged liver segments. The gallbladder was anastomosed to the widely opened bile duct in the hilus to form a widened pass way through the intrahepatic to the extrahepatic ducts. And the fundus of the gallbladder was mobilized and pulled to the abdominal wall to form a subcutaneous tunnel as a re-entry to the biliary tree. Results Totally 18 patients (41.9%) underwent resection of the liver,17 patients (39.5%) had residual stones. The rate of residual stone was 27.8% (5/18) in those treated by STHG combined with hepatectomy,and 48.0% (12/25) in those received STHG only. One patient developed biliary leakage and 1 patient had fungous infection after the operation. The 43 patients were followed up for a mean of 27.6 months (range,1-83). During the period,3 patients had recurrence of cholangitis and hepatolithiasis,1 showed cholangitis,and 1 had recurrent stones. The recurrent cases were cured by drainage or removing the stones through the subcutaneous tunnel. Conclusion STHG is safe,effective,minimally invasive and easy to manipulate for the treatment of hepatolithiasis.