Coexisting sharp ductal angulation with intrahepatic biliary strictures in right hepatolithiasis

Objective: To investigate the clinical characteristics of a coexisting sharp ductal angulation ( Design: Case-controlled study. Setting: A referral center. Patients: Eighteen consecutive patients having right-sided hepatolithiasis and a coexisting sharp ductal angulation associated with biliary stricture (group 1) were compared with 84 patients matched with sex, age, and conditions of hepatolithiasis and intrahepatic biliary stricture(s) but no sharp angulated duct (group 2). Intervention: Postoperative cholangioscopic management (electrohydraulic lithotripsy or other lithotripsy, lithotomy, balloon dilation, biopsy, etc, via T-tube tract or percutaneous transhepatic route). Main Outcome Measures: Sessions of manipulations, incidence of complications associated with interventions or disease, and mortality were compared. Results: Patients of group 1 needed more sessions of postoperative manipulation of stones and strictures (13.7±4.2 vs 8.0±2.3; P P P P P P P Conclusion: Our results suggest that the coexisting sharp ductal angulation with biliary strictures in right-sided hepatolithiasis is a distinct difficult clinical entity in the field of biliary tract calculi. (Arch Surg. 1994;129:1097-1102)