title: Hepatectomy with primary closure of common bile duct for hepatolithiasis combined with choledocholithiasis.
abstract: OBJECTIVE
  To evaluate the feasibility of hepatectomy and primary closure of common bile duct for intrahepatic and extrahepatic calculi.
  
  
  METHODS
  From January 2008 to May 2013, anatomic hepatectomy followed by biliary tract exploration without biliary drainage (non-drainage group) was performed in 43 patients with intrahepatic and extrahepatic calculi. After hepatectomy, flexible choledochoscopy was used to extract residual stones and observe the intrahepatic bile duct and common bile duct (CBD) for determination of biliary stricture and dilatation. Function of the sphincter of Oddi was determined by manometry of the CBD. Primary closure of the CBD without T-tube drainage or bilioenteric anastomosis was performed when there was no biliary stricture or sphincter of Oddi dysfunction. Dexamethasone and anisodamine were intravenously injected 2-3 d after surgery to prevent postoperative retrograde infection due to intraoperative bile duct irrigation, and to maintain relaxation of the sphincter of Oddi, respectively. During the same period, anatomic hepatectomy followed by biliary tract exploration with biliary drainage (drainage group) was performed in 48 patients as the control group. Postoperative complications and hospital stay were compared between the two groups.
  
  
  RESULTS
  There was no operative mortality in either group of patients. Compared to intrahepatic and extrabiliary drainage, hepatectomy with primary closure of the CBD (non-drainage) did not increase the incidence of complications, including residual stones, bile leakage, pancreatitis and cholangitis (P > 0.05). Postoperative hospital stay and costs were nevertheless significantly less in the non-drainage group than in the drainage group. The median postoperative hospital stay was shorter in the non-drainage group than in the drainage group (11.2 ± 2.8 d vs 15.4 ± 2.1 d, P = 0.000). The average postoperative cost of treatment was lower in the non-drainage group than in the drainage group (29325.6 ± 5668.2 yuan vs 32933.3 ± 6235.1 yuan, P = 0.005).
  
  
  CONCLUSIONS
  Hepatectomy followed by choledochoendoscopic stone extraction without biliary drainage is a safe and effective treatment of hepatolithiasis combined with choledocholithiasis.
authors.affiliation: Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, The Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
authors.forename: Chang-Ku
authors.initials: CK
authors.lastname: Jia
authors.affiliation: Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, The Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Weng
authors.affiliation: Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, The Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
authors.forename: You-Ke
authors.initials: YK
authors.lastname: Chen
authors.affiliation: Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, The Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
authors.forename: Qing-Zhuang
authors.initials: QZ
authors.lastname: Yang
authors.affiliation: Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, The Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, The Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
authors.forename: Qi-Fan
authors.initials: QF
authors.lastname: Qin
authors.affiliation: Chang-Ku Jia, Jie Weng, You-Ke Chen, Qing-Zhuang Yang, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, The Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003907:Dexamethasone / Q000008:administration & dosage; D004322:Drainage; D005240:Feasibility Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D020347:Lithiasis / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012991:Solanaceous Alkaloids / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D012991:Solanaceous Alkaloids; C003922:anisodamine; D003907:Dexamethasone
keywords: Biliary drainage; Choledocholithiasis; Hepatectomy; Hepatolithiasis; Primary closure
references.citation: Arch Surg. 2005 Oct;140(10):993-7
references.pmid: 16230551
references.citation: Eur J Gastroenterol Hepatol. 2002 Sep;14(9):1025-7
references.pmid: 12352225
references.citation: Ann Hepatol. 2006 Jan-Mar;5(1):44-8
references.pmid: 16531965
references.citation: Hepatobiliary Pancreat Dis Int. 2005 Nov;4(4):597-9
references.pmid: 16286271
references.citation: Am J Surg. 2006 Apr;191(4):460-4
references.pmid: 16531136
references.citation: Aust N Z J Surg. 1994 Dec;64(12):823-6
references.pmid: 7980254
references.citation: Rev Esp Enferm Dig. 2006 Aug;98(8):597-604
references.pmid: 17048996
references.citation: Br J Surg. 1991 Apr;78(4):470-2
references.pmid: 2032108
references.citation: World J Surg. 2007 Mar;31(3):479-82
references.pmid: 17334864
references.citation: Rev Esp Enferm Dig. 2008 Apr;100(4):225-9
references.pmid: 18563980
references.citation: World J Gastroenterol. 2006 Jul 14;12(26):4170-4
references.pmid: 16830367
references.citation: Ann Surg. 2001 Aug;234(2):210-4
references.pmid: 11505067
references.citation: Surgery. 2004 Apr;135(4):386-93
references.pmid: 15041962
references.citation: Am J Surg. 1984 Feb;147(2):253-9
references.pmid: 6696201
references.citation: Langenbecks Arch Surg. 2011 Jan;396(1):53-62
references.pmid: 20582601
references.citation: Arch Surg. 1995 Feb;130(2):194-7
references.pmid: 7848091
references.citation: Arch Surg. 2002 Feb;137(2):149-53
references.pmid: 11822950
references.citation: BMC Gastroenterol. 2008;8:4
references.pmid: 18267026
references.citation: Br J Surg. 1990 Sep;77(9):1075
references.pmid: 2207584
references.citation: Am J Surg. 1998 Jul;176(1):34-7
references.pmid: 9683129
references.citation: J Hepatobiliary Pancreat Surg. 2004;11(2):112-5
references.pmid: 15127273
references.citation: Am J Gastroenterol. 1995 Apr;90(4):540-8
references.pmid: 7717308
references.citation: Surgery. 2011 May;149(5):680-8
references.pmid: 21316725
references.citation: Acta Chir Belg. 1989 Nov-Dec;89(6):320-4
references.pmid: 2609838
references.citation: J Am Coll Surg. 1999 Aug;189(2):177-82
references.pmid: 10437840
references.citation: J Hepatobiliary Pancreat Surg. 2005;12(3):243-8
references.pmid: 15995814
references.citation: J Am Coll Surg. 1995 Jan;180(1):43-8
references.pmid: 8000654
references.citation: World J Surg. 1998 Nov;22(11):1162-6
references.pmid: 9828725
references.citation: HPB Surg. 2010;2010:791625
references.pmid: 20300546
references.citation: World J Gastroenterol. 2010 Jul 21;16(27):3423-6
references.pmid: 20632446
references.citation: Arch Surg. 1999 Jan;134(1):22-4
references.pmid: 9927125
references.citation: J Gastrointest Surg. 2007 May;11(5):626-30
references.pmid: 17468921
references.citation: World J Surg. 2008 Mar;32(3):413-8
references.pmid: 18196323
references.citation: Surgery. 1988 Apr;103(4):408-10
references.pmid: 3353854
references.citation: J Am Coll Surg. 2006 Feb;202(2):306-12
references.pmid: 16427557
references.citation: J Clin Gastroenterol. 2004 Apr;38(4):364-7
references.pmid: 15087697
references.citation: Chin Med J (Engl). 2010 Jan 20;123(2):137-41
references.pmid: 20137359