title: Endoscopic or laparoscopic approach for hepatolithiasis in the era of endoscopy in China.
abstract: BACKGROUND
  Many endoscopic procedures have been used to treat hepatolithiasis, including as laparoscopic hepatectomy (LH), laparoscopic intrahepatic duct exploration (LIDE), and endoscopic retrograde cholangiopancreatography (ERCP). However, long-term results of such treatments are rarely reported. The series aimed to evaluate the immediate outcomes and long-term results of these treatments and their optimal indications.
  
  
  METHODS
  From January 2002 to April 2010, a total of 124 continuous patients with hepatolithiasis were primarily treated with endoscopic surgery, including LH (LH group, n = 37), LIDE (LIDE group n = 41), and ERCP (ERCP group, n = 46) at our two institutes. These cases were retrospectively reviewed. The patients' demographic variables, operative outcomes, complete clearance rate, and cholangitis recurrence rate were analyzed.
  
  
  RESULTS
  Complete stone clearance was achieved in 94.6 % of LH, 78.0 % of LIDE, and 67.4 % of ERCP patients. After a median follow-up period of 5.0 years (rang 2-8 years), we observed stone recurrence in 26.6 % (33/124) of patients and recurrent cholangitis in 24.2 % (30/124) of patients. Stricture, stones in both lobes, and non-hepatectomy treatments were significant risk factors for incomplete stone clearance on multivariate analysis. In addition, recurrent cholangitis was associated with non-hepatectomy therapy, Sphincter of Oddi dysfunction, residual stones, and intrahepatic bile strictures.
  
  
  CONCLUSIONS
  In this study with 2-8 years of follow-up, residual stones, biliary stricture, Sphincter of Oddi dysfunction, and ERCP therapy were associated with recurrent stones and/or cholangitis after treatment, indicating that the modification of Sphincter of Oddi function and maintaining its normal pressure are very important.
authors.affiliation: Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China, tanjingwang02@aliyun.com.
authors.forename: JingWang
authors.initials: J
authors.lastname: Tan
authors.forename: YunChang
authors.initials: Y
authors.lastname: Tan
authors.forename: Fei
authors.initials: F
authors.lastname: Chen
authors.forename: YuL
authors.initials: Y
authors.lastname: Zhu
authors.forename: JianJun
authors.initials: J
authors.lastname: Leng
authors.forename: JiaHong
authors.initials: J
authors.lastname: Dong
mesh_terms: D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D002681:China; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000209:etiology; D002780:Cholestasis, Intrahepatic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome