Coexisting sharp ductal angulation with intrahepatic biliary strictures in right hepatolithiasis
K. S. Jeng, I. Ohta, F. S. Yang, T. P. Liu, S. C. Shih, W. S. Chang, H. Y. Wan and S. H. Huang
Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
OBJECTIVE: To investigate the clinical characteristics of a coexisting
sharp ductal angulation (< 90 degrees) with biliary stricture and to
evaluate the difficulties it imposes in the management of retained or
recurrent hepatolithiasis. DESIGN: Case-controlled study. SETTING: A
referral center. PATIENTS: Eighteen consecutive patients having right-sided
hepatolithiasis and a coexisting sharp ductal angulation associated with
biliary stricture (group 1) were compared with 84 patients matched with
sex, age, and conditions of hepatolithiasis and intrahepatic biliary
stricture(s) but no sharp angulated duct (group 2). INTERVENTION:
Postoperative cholangioscopic management (electrohydraulic lithotripsy or
other lithotripsy, lithotomy, balloon dilation, biopsy, etc, via T-tube
tract or percutaneous transhepatic route). MAIN OUTCOME MEASURES: Sessions
of manipulations, incidence of complications associated with interventions
or disease, and mortality were compared. RESULTS: Patients of group 1
needed more sessions of postoperative manipulation of stones and strictures
(13.7 +/- 4.2 vs 8.0 +/- 2.3; P < .001). During management, there was a
significantly increased vulnerability of severe and/or recurrent
cholangitis (66.7% vs 9.5%; P < .001), septic shock (77.8% vs 11.9%; P
< .001), liver abscess (55.6% vs 7.1%; P < .001), or massive
hemobilia (33.3% vs 7.4%) in group 1 than in group 2. Their risks of
coexisting secondary biliary cirrhosis (55.6% vs 9.5%; P < .001) and/or
cholangiocarcinoma (16.6% vs 2.4%; P < .04) and mortality (27.8% vs
4.8%; P < .01) were also significantly higher in group 1. CONCLUSION:
Our results suggest that the coexisting sharp ductal angulation with
biliary strictures in right-sided hepatolithiasis is a distinct difficult
clinical entity in the field of biliary tract calculi.
