Clinical Study of Biliary Tract Stones.
- Author:
Beom Gyu KIM
1
;
Yong Keum PARK
;
Kyong Choun CHI
;
Jung Hyo LEE
;
In Taik CHANG
;
Sang Jhoon KIM
Author Information
1. Department of General Surgery, College of Medicine, Chung-ng University, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Biliary tract stones
- MeSH:
Alanine Transaminase;
Alkaline Phosphatase;
Aspartate Aminotransferases;
Bacteria;
Bile;
Biliary Tract*;
Cause of Death;
Cholecystectomy;
Choledocholithiasis;
Common Bile Duct;
Far East;
Gallbladder;
Hepatectomy;
Humans;
Korea;
Mortality;
Postoperative Complications;
Reoperation;
Retrospective Studies;
Sepsis;
Sex Ratio;
Surgical Procedures, Operative;
Wound Infection
- From:Journal of the Korean Surgical Society
1998;55(6):900-909
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Residual stones after biliary tract surgery are a formidable task for the surgeon. Choledocholithiasis and hepatolithiasis are more common in East Asia, including Korea, compared with the West, and retained and recurrent stones remain a major problem after the surgical treatment of biliary tract stones; thus, various attempts to reduce the rate of retained and recurrent stones are important in the treatment of biliary tract stones. METHODS: A retrospective analysis was done on 815 cases of patients with biliary tract stones who had undergone an operation at the Department of Surgery, Chung-ng University Hospital, during the 13 years from January 1984 to December 1996. RESULTS: The male-to-female sex ratio was 1 : 2, and the most common age group was the 7th decade. The most common symptoms and physical findings were right upper quadrant pain in 620 cases (76.1%), and right upper quadrant tenderness in 511 cases (62.1%). The most common laboratory findings were elevated alkaline phosphatase (88.3%), followed by elevated sGPT and elevated sGOT. Bile cultures and sensitivity tests were done in 815 cases and were positive in 682 cases (83.7%). The most common bacteria were E.coli in 252 cases (37.0%). The locations of the stones were gallbladder (GB) and common bile duct (CBD) in 420 cases (51.5%), the CBD in 160 cases (19.6%), the CBD and intrahepatic duct (IHD) in 108 cases (13.3%). The most common operative procedure was a cholecystectomy with T-ube insertion, 525 cases (64.4%). Postoperative complications developed in 208 cases (25.6%), and the most common postoperative complication was wound infection, 72 cases (8.8%). The operative mortality was 2.9%, and most common cause of death was sepsis (10 cases). CONCLUSIONS: The authors conclude that interventional therapy, as an initial treatment for residual stones, is a satisfactory treatment where possible. If there are residual stones in spite of the interventional therapy, a reoperation or hepatectomy is required.
