Clinical Indications for Biliary Drainage Procedures

Ahn, Chang Hyeok; Jang, Beong Kook; Ahn, Chang Joon

Abstract

Inspite of the benign disease process, the management of intrahepatic duct stones is difficult because of complications such as recurrent ascending cholangitis, liver abscess, sepsis, secondary liver cirrhosis, cholangiocarcinoma, and high recurrence rates. Also they are sometimes difficult to remove completely due to their anatomical locations. The principles of their surgical management are composed of complete removal of the stone and prevention of biliary stasis. The commonly used biliary drainage procedures are transduodenal sphincteroplasty, choledochoduodenostomy, and Roux-en-Y choledochojejunostomy. The results of biliary drainage procedures in 82 patients at the Department of Surgery, Taejon St. Mary's Hospital, from January 1985 through December 1994 were reviewed, including a follow-up study. The incidence of biliary drainage procedures, including hepatic resections, was 18.9% of the 433 patients operated on for cholelithiasis. The male- to- female ratio was 1 : 1.5; the sixth decade was the most common age. The common clinical symptoms and physical signs were right upper quadrant and epigastric pain and tenderness (89.0%), jaundice (56%), and fever and chills (47.4%). Fifty-six percent of the cases involved the first incidence of a biliary operation, 34.1% a second incidence, and 9.7% a third. The biliary stones were located at only the intrahepatic area (31.7%), both the intrahepatic and the extrahepatic areas (35.3%), or both the gall bladder and the extrahepatic area (29.0%). Of the intrahepatic stones, the left lobe was involved in 45.5% of the cases, the right lobe in 9%, and both lobes in 45.5%. The indications for biliary drainage procedures were acute obstructive cholangitis (36.5%), recurrent stones (34.1%), biliary dyskinesia (21.9%), and liver abscess (7.3%). The types of biliary drainage procedures were choledochoduodenostomy (43.9%), Roux-en-Y choledochojejunostomy (21.9%), left hepatic lobectomy (14.6%), left lateral hepatic segmentectomy (8.5%), Roux-en-Y hepaticojejunostomy (8.5%), right hepatic lobectomy (1.2%), and transduodenal sphincteroplasty (1.2%). The early postoperative complications were wound infection (24.3%), pulmonary complications (19.5%), anastomosis leakage (2.4%), etc. The operative mortality was 1.2%. The late complications during the follow-up period were recurrent stones (11 cases), ascending cholangitis (8 cases), and liver abscess (5 cases).