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A Limiting Factor in the Treatment of Hepatolithiasis

Kuo-Shyang Jeng, MD; Shou-Chuan Shih, MD; Hsein-Jar Chiang, MD; Bee-Fong Chen, MD

Arch Surg. 1989;124(11):1301-1305.

Abstract
• To investigate whether the coexistence of secondary biliary cirrhosis plays a limiting role in the treatment of hepatolithiasis, we retrospectively compared the clinical course and results of stone treatment in 30 patients with secondary biliary cirrhosis (8 in Child's class A and 22 in Child's class B) (group 1) and 240 patients with noncirrhotic biliary calculi (group 2). The hospital mortality, morbidity of treatment, mortality of treatment, and the percentage of treatment failure in group 1 were 20%, 40%, 6.7%, and 16.7%, respectively. Those in group 2 were 8%, 10%, 3.8%, and 10%, respectively. The modes of treatment for stone removal included surgery with postoperative cholangioscopy and percutaneous transhepatic cholangioscopy. There was a statistically significant difference between these two groups in the hospital mortality and the morbidity of treatment. We conclude that hepatolithiasis and biliary stricture should be treated early, before the development of secondary biliary cirrhosis. However, even after cirrhosis occurs, aggressive treatment does not increase the mortality of treatment or the treatment failure rate.

(Arch Surg. 1989;124:1301-1305)

Author Affiliations
From the Departments of Surgery (Dr Jeng), Gastroenterology (Dr Shih), Radiology (Dr Chiang), and Pathology (Dr Chen), Mackay Memorial Hospital, Taipei City, Taiwan.

Footnotes
Accepted for publication April 3, 1989.

Reprint requests to Department of Surgery, Mackay Memorial Hospital, No. 92, Section 2, Chung-Shan North Road, Taipei City, Taiwan 10449, Republic of China (Dr Jeng).

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