The clinical symptomatology of cholelithiasis in 1960' of Korea was very complicated due to high incidence of extra-cholecystic stones, including common bile duct stones and intrahepatic calculi, protracted history of gallstone disease and
frequent
use
of farmyard manures of animal and human excrement.
This complicated clinical picture are changing and improving year by year and it is probably due to a higher kcal diet with increased ratio of fat and protoin, and it coincides with goverment production of chemical fertilizer and no longer use of
the
farmyard manures.
Despite these changes and improvement, incidence of intrahepatic calculi did not much change, and it is still around 10% of all galls one population.
Since 1960's, to have a better operative cholangiogram we used dye-dilution technic which demonstrated that the Korean intrahepatic calculi are often associated with intrahepatic stenosis. The stones and bile trapped above the stenosis must be
drained
well, otherwise symptoms may recur.
Instead of conventional Roux-Y-choledocho-jejunostomy, the by-pass operation was individualized according to type of intrahepatic calculi, classified by the site of stenosis observed.
Intrahepatic calculi associated with stenosis was named compound intrahepatic calculi. Thpe B 1 is that stenosis in hepatic hilum. Type B 2 is that stenosis in left intrahepatic duct. Type B 2 is that stenosis in right intrahepatic duct. This is
subdivided into Type B-3-A and Type B-3-P, Type B-3-A is that stenosis in antorior segmental duct of right lobe of liver. Type B-3-P is that stenosis in the posterior segmental duct. Type B-4 is that stenosis in both intrahepatic duct.
Each case of different type were described. Over 10 20 years follow p study show that the individualized By-pass operation seems better than that of the conventional By-pass operation.
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