Multiple stenting in complex choledocholithiasis as a cause of severe morphological changes in the liver

Aim. To study the structural changes in liver tissue resulting from stenting, the dependence of these structural changes on the duration of stenting of the common bile duct, and the incidence of obstructive jaundice.

Materials and methods. The study groups consisted of 45 patients with choledocholithiasis. Group 1 included 13 patients who experienced cholangitis 1–2 times, while Group 2 comprised 32 patients with recurrent cholangitis occurring more than twice, necessitating multiple stenting of the common bile duct.

Results. The duration and frequency of stenting of the common bile duct, as well as the recurrence of cholangitis, lead to hyperplasia of the bile ducts up to severe hepatocellular disease with the formation of portocaval septa and severe cholangiohepatitis, accompanied by loss of functional capacity. Multiple stenting in choledocholithiasis, in the absence of somatic diseases that hinder radical treatment, is considered inadmissible. Due to structural complications, re-stenting should only be performed based on strict life indications.

Conclusion. Complex choledocholithiasis should be maximally resolved during repeated hospitalization – either endoscopically or surgically – within a timeframe of 3 to 6 weeks after amelioration of the clinical picture of obstructive jaundice and normalization of laboratory parameters.

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