Histopathologic changes in the intra- and extrahepatic biliary tree in patients with postcholecystectomy choledocholithiasis.
To assess the incidence of biliary stasis in recurrent choledocholithiasis, 155 patients with postcholecystectomy choledocholithiasis, all of whom were recommended for choledochoduodenostomy, are presented in this paper. Data show that in patients of advanced age and with a long history of the disease there is a higher incidence of common bile duct dilatation, primary common bile duct stones, and increased bile contamination rate. Furthermore, these elements are associated with advanced pathologic changes in the liver and biliary tree histology. This hypothesis is supported by barium meal studies through the constructed choledochoduodenostomy where the extent and progress of those pathologic changes have been illustrated by visualization of the entire biliary tree at different postoperative intervals. In this series of patients, the progress of the liver and biliary damage was studied after the relief of the obstruction. It would appear reasonable to accept that in patients with the above-mentioned characteristics, the evidence of biliary stasis is clear. In these patients, the demand for a drainage procedure supplementary to choledochotomy seems to be warranted in order to eliminate the risk of recurrent choledocholithiasis as a result of existing biliary stasis.
D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001659:Biliary Tract / Q000000981:diagnostic imaging; D002763:Cholecystectomy; D001651:Cholestasis, Extrahepatic / Q000473:pathology*; D002780:Cholestasis, Intrahepatic / Q000473:pathology*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D042882:Gallstones / Q000473:pathology*; D006500:Hepatic Duct, Common / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D012008:Recurrence