World journal of gastrointestinal surgery · 2026
Clinical characteristics of and risk factors for hepatolithiasis developed after surgery for congenital biliary dilatation.
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Asano Fumio, Matsuyama Ryusei, Kumamoto Takafumi, Shinkai Masato, Morioka Daisuke, Shinoda Satoru, Endo Itaru
Аннотация
BACKGROUND: Pancreaticobiliary maljunction (PBM) is a congenital disease in which the pancreatic and bile ducts fuse outside the duodenal wall. Congenital biliary dilatation (CBD) involves PBM and dilatation of the extrahepatic bile duct. The lack of Oddi sphincter action at the confluence results in the retrograde flow of pancreatic juice into the bile duct, placing patients with CBD at high risk of biliary carcinoma. The standard treatment for CBD is complete extrahepatic bile duct resection (EHBR). Hepatolithiasis (HL), a late complication following CBD surgery, has a deleterious clinical impact; further research is necessary to elucidate its risk factors.
AIM: To clarify the clinical impact of and risk factors for HL after CBD surgery.
METHODS: A retrospective study was conducted with 223 CBD patients who underwent EHBR across three tertiary hospitals to investigate postoperative complications. An exploratory analysis was performed to identify factors associated with HL development. Risk factors were subsequently identified using least absolute shrinkage and selection operator (LASSO) analysis.
RESULTS: HL was observed in 15/223 (6.7%) patients. Two of those patients developed liver failure owing to biliary cirrhosis; one died, and the other received liver transplantation. Two patients required major hepatectomy. The majority of the remaining patients required repeated enteroscopic and/or percutaneous lithotomy procedures. LASSO analysis revealed older age at surgery as an independent risk factor for HL; the time-dependent receiver operating characteristic analysis at 6 years after surgery revealed a cutoff age of 31 years.
CONCLUSION: HL following CBD surgery has a markedly deleterious clinical impact. Advanced age at the time of CBD surgery was identified as an independent risk factor for HL.
AIM: To clarify the clinical impact of and risk factors for HL after CBD surgery.
METHODS: A retrospective study was conducted with 223 CBD patients who underwent EHBR across three tertiary hospitals to investigate postoperative complications. An exploratory analysis was performed to identify factors associated with HL development. Risk factors were subsequently identified using least absolute shrinkage and selection operator (LASSO) analysis.
RESULTS: HL was observed in 15/223 (6.7%) patients. Two of those patients developed liver failure owing to biliary cirrhosis; one died, and the other received liver transplantation. Two patients required major hepatectomy. The majority of the remaining patients required repeated enteroscopic and/or percutaneous lithotomy procedures. LASSO analysis revealed older age at surgery as an independent risk factor for HL; the time-dependent receiver operating characteristic analysis at 6 years after surgery revealed a cutoff age of 31 years.
CONCLUSION: HL following CBD surgery has a markedly deleterious clinical impact. Advanced age at the time of CBD surgery was identified as an independent risk factor for HL.