Recurrent pyogenic cholangitis with hepatolithiasis--the role of surgical therapy in North America.
OBJECTIVE
To determine role of surgical intervention for Recurrent Pyogenic Cholangitis with hepatolithiasis at a North American hepatobiliary center.


METHODS
Retrospective analysis of 42 patients presenting between 1986 and 2005.


RESULTS
Mean age is 54.3 years (24-87). Twenty-seven patients (64%) underwent surgery, after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous intervention in 19/27 patients. Surgical procedures were: 10 common bile duct explorations with choledochojejunostomy and a Hutson loop and 17 hepatectomies (10 with, 7 without Hutson loop). Liver resection was indicated for lobar atrophy or stones confined to single lobe. Operative mortality was zero; complication rates for hepatectomy and common bile duct exploration were comparable (35% vs. 30%). Median follow-up was 24 months (3-228). Of 21 patients with Hutson loops, only seven (33%) needed subsequent loop utilization, with three failures. At last follow-up, 4/27 (15%) surgical patients had stone-related symptoms requiring percutaneous intervention, compared to 4/11 (36%) surviving nonoperative patients. Cholangiocarcinoma was identified in 5/42 (12%) patients; four were unresectable and one was an incidental in-situ carcinoma in a resected specimen.


CONCLUSIONS
Surgery is a valuable part of multidisciplinary management of recurrent pyogenic cholangitis with hepatolithiasis. Hepatectomy is a useful option for selected cases. Hutson loops are useful in some cases for managing stone recurrence. Cholangiocarcinoma risk is elevated in this disease.
Al-Sukhni
Wigdan
W
Division of General Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, NCSB11-1244, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
Gallinger
Steven
S
Pratzer
Ariella
A
Wei
Alice
A
Ho
C S
CS
Kortan
Paul
P
Taylor
Bryce R
BR
Grant
David R
DR
McGilvray
Ian
I
Cattral
Mark S
MS
Langer
Bernard
B
Greig
Paul D
PD
D000328:Adult; D000368:Aged; D000465:Algorithms; D001649:Bile Duct Diseases / Q000453:epidemiology*; D001650:Bile Duct Neoplasms / Q000453:epidemiology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D018281:Cholangiocarcinoma / Q000453:epidemiology; D002761:Cholangitis / Q000453:epidemiology* / Q000601:surgery*; D004108:Dilatation, Pathologic; D005260:Female; D005334:Fever / Q000209:etiology; D042882:Gallstones / Q000453:epidemiology*; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies