Laparoscopic cholecystectomy plus common bile duct exploration for extrahepatic bile duct stones and postoperative recurrenceassociated risk factors

BACKGROUND There remain controversies regarding the surgical treatment of extrahepatic bile duct stones(EHBDSs)in clinical practice.AIM To explore the curative effect of laparoscopic cholecystectomy(LC)plus common bile duct exploration(CBDE)for the surgical treatment of EHBDSs and to analyze the risk factors that affect postoperative stone recurrence.METHODS Eighty-two patients with EHBDSs admitted between March 2017 and March 2023 were selected.Among them,patients treated with open choledocholithotomy plus LC or open cholecystectomy(OC)were set as the control group(n=40),and those treated with LC plus CBDE served as the observation group(n=42).The surgical outcomes of the two groups were compared,the surgical complications and Gas-trointestinal Quality of Life Index(GIQLI)scores were counted,and the one-year prognostic recurrence was recorded.Independent factors for postoperative re-currence were determined using univariate and multivariate analyses.RESULTS The two groups were comparable in the stone residual rate(P>0.05).The ope-ration time(P<0.05),intraoperative bleeding(P<0.05),and total complication rate(P=0.005)were lower in the observation group than in the control group.The observation group exhibited a marked increase in the GIQLI score,which was higher than the control group(P<0.05).A lower one-year recurrence rate was determined in the observation group vs the control group(P=0.027).Sphincter of Oddi dysfunction[odds ratio(OR)=5.712,P=0.007]and the treatment scheme of open choledocholithotomy plus LC or OC(OR=6.771,P=0.008)were the independent risk factors for one-year recurrence in patients after surgery.CONCLUSION LC plus CBDE for patients with EHBDSs can reduce stone residuals,intraoperative bleeding,complications,and postoperative recurrence.

Favorable outcomes of hilar duct oriented hepatic resection for high grade Tsunoda type hepatolithiasis

AIM： To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure （VHE） method that has been applied by the authors. METHODS： From June 1994 to June 2004 for a period of 10 years, 153 patients who had Tsunoda type Ⅲ or Ⅳ hepatolithiasis, received hepatectomy at our institution. Among these patients, 128 who underwent hepatectomy by the VHE method were the subjects for the study. We analyzed the risk of this procedure, residual rate of intrahepatic stones, and stone recurrent rates. RESULTS： The average age was 54.2 years, and the male to female ratio was 1：1.7. The average follow-up period was 25.6 mo （6-114 too）. There was no postoperative severe complication or mortality after the operation. The rate of residual stones was 5.4% and the rate of recurrent stones was 4.2%. CONCLUSION： VHE is a safe surgical procedure and provides favorable treatment results of intractable hepatolithiasis. Especially, this procedure has advantage in that intra-hepatic bile duct stricture may be confirmed and corrected directly during surgery.

Compliance in patients with dietary hyperoxaluria: A cohort study and systematic review

Objective:Hyperoxaluria leads to calcium oxalate crystal formation and subsequent urolithiasis.This study aims to analyse the effect of treatment compliance in hyperoxaluria,firstly by analysis of patients with non-primary hyperoxaluria and secondly via systematic review in patients with any hyperoxaluria.Methods:In a retrospective cohort study,adults with non-primary hyperoxaluria managed with dietary counselling in 2013 were enrolled.Twenty-four-hour(24 h)urine collections initially and at 6 months were obtained.Compliance was assessed by self-reported dietary compliance and 24 h urinary volume>2 L.Patients were followed for 24 months.Primary outcomes were urinary oxalate and calcium 24 h load at 6 months,and urolithiasis-related procedural rates at 24 months.A Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)-compatible systematic review of compliance among hyperoxaluric patients was performed.Results:In the cohort study,of 19 eligible patients(4 female)with median age 52 years,10(53%)were considered compliant.Compared with the non-compliant group,these patients had significantly increased subsequent 24 h urinary volume(2250 mL vs.1600 mL;p=0.008)and lower procedural rates(10%vs.56%;p=0.033).Subsequent 24 h urinary oxalate load was nonsignificantly lower in compliant patients.Systematic review regarding compliance in hyperoxaluric patients revealed five studies.Only one utilised dietary counselling or analysed compliant vs.non-compliant patients,finding no difference.None examined the effect of compliance on procedural rates.