Routine guide-wire application facilitates cholangioscopy in the management of postoperative residual hepatolithiasis

Abstract

Objectives

Although postoperative cholangioscopy (POC) is considered to be an effective treatment for residual hepatolithiasis after surgery, its security and validity still needs to be improved. This study compared wire-guided POC (WG-POC) versus traditional POC (T-POC) in the management of patients with residual hepatolithiasis.

Methods

This retrospective study included a total of 203 patients who suffered from hepatolithiasis and underwent hepatectomy as initial intervention from January 1, 2016, to January 1, 2017. After surgery, 110 patients were subjected to T-POC and 93 to WG-POC for eliminating residual hepatolithiasis. The perioperative course and follow-up outcomes were retrospectively analyzed.

Results

No significant differences in clinical characteristics or distribution of residual hepatolithiasis between the WG-POC and T-POC groups were observed (P>0.05). However, the overall POC interventional sessions (2.9±0.85 vs. 4.0±1.21 times), average operating time (264.8±103.61 vs. 389.4±136.26 minutes), overall complications rate (18.28% vs. 32.73%), and the overall T-tube retaining time (21.8±6.20 vs. 28.8±8.09 days) were lower in WG-POC group than in the T-POC group (P<0.05). In addition, there were no significant differences between the two groups (WG-POC vs. T-POC) in recurrence (4.30% vs. 4.55%) and residual calculi (8.60% vs. 6.36%) at half-a year follow up (P>0.05).

Conclusions

Routine wire guidance may improve the outcome of cholangioscopy in managing complicated residual hepatolithiasis, being associated with clear advantages such as shorter operating time and number of POC interventions, reduced T-tube retaining time, and fewer postoperative complications.

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