title: Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma for hepatolithiasis.
abstract: OBJECTIVE
  To evaluate the long-term outcomes of Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS) and risk factors for recurrence in hepatolithiasis.
  
  
  METHODS
  From March 1993 to December 2012, 202 consecutive patients with hepatolithiasis underwent OSPCHS at our department. The Oddi sphincter preserved procedure consisted of common hepatic duct exploration, stone extraction, hilar bile duct plasty, establishment of subcutaneous stoma to the bile duct. Patients with recurrent stones can undergo stone extraction and/or biliary drainage via the subcutaneous stoma which can be incised under local anesthesia. The long-term results were reviewed. Cox regression model was employed to analyze the risk factors for stone recurrence.
  
  
  RESULTS
  Ninety-seven (48.0%) OSPCHS patients underwent hepatic resection concomitantly. The rate of surgical complications was 10.4%. There was no perioperative death. The immediate stone clearance rate was 72.8%. Postoperative cholangioscopic lithotomy raised the clearance rate to 97.0%. With a median follow-up period of 78.5 mo (range: 2-233 mo), 24.8% of patients had recurrent stones, 2.5% had late development of cholangiocarcinoma, and the mortality rate was 5.4%. Removal of recurrent stones and/or drainage of inflammatory bile via subcutaneous stoma were conducted in 44 (21.8%) patients. The clearance rate of recurrent stones was 84.0% after subsequent choledochoscopic lithotripsy via subcutaneous stoma. Cox regression analysis showed that residual stone was an independent prognostic factor for stone recurrence.
  
  
  CONCLUSIONS
  In selected patients with hepatolithiasis, OSPCHS achieves excellent long-term outcomes, and residual stone is an independent prognostic factor for stone recurrence.
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Yu-Gui
authors.initials: YG
authors.lastname: Lian
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Wei-Tao
authors.initials: WT
authors.lastname: Zhang
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Ling
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Wang
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Chun-Sheng
authors.initials: CS
authors.lastname: Hou
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Long
authors.initials: L
authors.lastname: Cui
authors.affiliation: Yu-Gui Lian, Wei-Tao Zhang, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Long Cui, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Xiao-Si
authors.initials: XS
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D004322:Drainage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D020347:Lithiasis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D009803:Sphincter of Oddi / Q000503:physiopathology*; D054047:Surgical Stomas / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hepatectomy; Hepaticoplasty; Hepatolithiasis; Sphincter of Oddi; Stone recurrence