title: Recurrent pyogenic cholangitis with hepatolithiasis--the role of surgical therapy in North America.
abstract: 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.
authors.affiliation: Division of General Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, NCSB11-1244, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
authors.forename: Wigdan
authors.initials: W
authors.lastname: Al-Sukhni
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Ariella
authors.initials: A
authors.lastname: Pratzer
authors.forename: Alice
authors.initials: A
authors.lastname: Wei
authors.forename: C S
authors.initials: CS
authors.lastname: Ho
authors.forename: Paul
authors.initials: P
authors.lastname: Kortan
authors.forename: Bryce R
authors.initials: BR
authors.lastname: Taylor
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
authors.forename: Ian
authors.initials: I
authors.lastname: McGilvray
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cattral
authors.forename: Bernard
authors.initials: B
authors.lastname: Langer
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
mesh_terms: 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