title: Middle and long-term clinical outcomes of patients with regional hepatolithiasis after subcutaneous tunnel and hepatocholangioplasty with utilization of the gallbladder.
abstract: BACKGROUND
  Roux-en-Y choledochojejunostomy is routinely performed in patients with regional hepatolithiasis. However, some of these patients, who have a normal gallbladder and normal Oddi's sphincter, are unnecessarily undergoing bilio-intestinal drainage. Alternatively, reconstruction can be achieved by subcutaneous tunnel and hepatocholangioplasty with the utilization of the gallbladder (STHG). This method is effective to potential endoscopic tunnel and intervention during follow-up, and prevention of reflux cholangitis as well as the disorders of the GI tract.
  
  
  METHODS
  The middle and long-term complications of 46 patients who underwent STHG were analyzed. With B-ultrasonography and biochemical assay, the contraction and concentration function of the gallbladder were also studied.
  
  
  RESULTS
  Follow-up showed that all patients survived with a relatively normal life. One patient experienced right epigastric pain, chills and fever because of a stone which impacted in the left hepatic bile duct. Another patient had cholangitis because of biliary ascariasis. The two patients were treated by endoscopic therapy within the subcutaneous gallbladder under local anesthesia.
  
  
  CONCLUSIONS
  This operation not only keeps the normal physical functional of the gallbladder, Oddi's sphincter and gastrointestinal tract, but also prevents reflux cholangitis and the disorder of the digestive tract. Hence STHG is a novel operation dealing with regional hepatolithiasis.
authors.affiliation: Department of General Surgery, Chengdu Military General Hospital, Chengdu 610083, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Shi
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Fu-Zhou
authors.initials: FZ
authors.lastname: Tian
mesh_terms: D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures; D002768:Choledochostomy; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome