title: Hepaticojejunostomy for hepatolithiasis: a critical appraisal.
abstract: OBJECTIVE
  To evaluate the long-term outcome and surgical indications of hepaticojejunostomy (HJ) for the treatment of hepatolithiasis.
  
  
  METHODS
  Three hundred and fourteen elective cases with hepatolithiasis but without biliary stricture or cystic dilatation treated in the past 10 years were reviewed retrospectively. The patients were divided into HJ group and T tube drainage group according to biliary drainage procedure. Furthermore, four subgroups were subdivided by hepatectomy as a balance factor, group A(1): hepatectomy+HJ; group A(2): choledochoctomy+HJ; group B(1): hepatectomy + choledochoctomy T tube drainage; group B(2): choledochoctomy + T tube drainage. The stone residual rate, surgical efficacy and long-term outcome were compared among different procedures.
  
  
  RESULTS
  There was no surgical mortality among all patients. The total hospital mortality was 1.6%. The overall stone residual rate after surgical clearance was 25.9%. There was no statistical difference between HJ group and T tube drainage group in terms of stone residual rate after surgical clearance, however, after postoperative choledochoscopic lithotripsy, the total stone residual rate of T tube drainage group was significantly lower than that of HJ group (0.5% vs 16.7%, P < 0.01). Hepatectomy + choledochoctomy tube drainage achieved the optimal therapeutic effect, only 8.2% patients suffered from an attack of cholangitis postoperatively, which was significantly lower than that of hepatectomy + HJ (8.2% vs 22.0%, P = 0.034). The major reason for postoperative cholangitis was stone residual in the HJ group (16/23, 70.0%), and stone recurrence in the T tube drainage group (34/35, 97.1%). The operative times were significantly prolonged in those undergoing HJ, and the operative morbidity of HJ was higher than those of T tube drainage.
  
  
  CONCLUSIONS
  The treatment result of HJ for hepatolithiasis is not satisfactory in this retrospective study due to high rate of stone residual and postoperative cholangitis. HJ could not drain residual stone effectively. HJ may hinder post-operative choledochoscopic lithotripsy, which is the optimal management for postoperative residual stone. The indications of HJ for hepatolithiasis should be strictly selected.
authors.affiliation: Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yet-san University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Shao-Qiang
authors.initials: SQ
authors.lastname: Li
authors.forename: Li-Jian
authors.initials: LJ
authors.lastname: Liang
authors.forename: Bao-Gang
authors.initials: BG
authors.lastname: Peng
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Lai
authors.forename: Ming-De
authors.initials: MD
authors.lastname: Lu
authors.forename: Dong-Ming
authors.initials: DM
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002761:Cholangitis / Q000209:etiology; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D020347:Lithiasis / Q000601:surgery*; D008096:Lithotripsy / Q000295:instrumentation / Q000379:methods; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome