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Correspondence and Brief Communications
July 1, 2006

Liver Resection for Complicated Hepatolithiasis—Reply

Arch Surg. 2006;141(7):713-714. doi:10.1001/archsurg.141.7.714-a

In reply

We thank Krige and Beningfield for their comment. Our results are based on the data of a selected group of patients.1 We believe that by extending the indication of liver resection to more complicated diseases, we can improve the outcome. The use of a hepaticojejunal loop either as a stoma2,3 or as a subparietal loop4 provides good access for future use. It may be a valuable procedure in combination with liver resection; however, there are limitations. There may be an increased incidence of cholangitis owing to bile stasis and bacterial overgrowth in the afferent jejunal limb. The procedure may pose additional risks such as the development of fistula, parajejunostomy hernia, or bowel kinking. In 1 series, 12 of 41 patients required opening of the jejunal loop for stone removal at a median of 27 months. It was difficult to reopen the stoma in 2 patients. Subsequently, symptoms recurred in 3 of these 12 patients but only 1 benefited by reopening of the stoma and stone removal.3

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