Surgical treatment of recurrent pyogenic cholangitis
S. C. Stain, R. Incarbone, C. R. Guthrie, P. W. Ralls, S. Rivera-Lara, D. Parekh and A. E. Yellin
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
OBJECTIVE: To examine the evolving operative strategies in the treatment of
recurrent pyogenic cholangitis (RPC). DESIGN: Case series of patients with
RPC treated surgically at the Los Angeles County-University of Southern
California Medical Center between 1980 and 1994. SETTING: Public teaching
hospital. PATIENTS: Twenty patients with RPC were studied. The clinical
diagnosis of RPC was made in patients with a syndrome of chronic
intermittent attacks of biliary sepsis associated with intrahepatic biliary
strictures and intrahepatic stones. MAIN OUTCOME MEASURE: The need for
repeated biliary intervention after surgical treatment of RPC. RESULTS:
Four patients had a hepatic lobectomy without biliary enteric bypass. One
patient had an uneventful course. Three patients had postoperative biliary
sepsis, and one of these patients died. A hepaticojejunostomy without a
cutaneous stoma was performed in eight patients. Five (63%) of these eight
required repeated operation for biliary sepsis 1 to 4 years after surgery.
In eight patients, a Roux-en-Y hepaticojejunostomy was performed after
attempted clearance of intrahepatic stones with construction of a temporary
cutaneous stoma. Postoperatively, these eight patients had 16 transstomal
endoscopic cholangiograms (mean follow-up, 10 months). Stones proximal to
intrahepatic strictures were identified in seven endoscopic sessions in
five of these patients (63%). The stones were removed, and the strictures
were endoscopically dilated. None required repeated biliary operation.
CONCLUSION: RPC is a progressive, lifelong disease. Construction of a
hepaticojejunostomy with a cutaneous stoma allows future therapeutic
intervention without the need for repeated surgery.
