Recurrent pyogenic cholangitis (RPC) is characterized by repeated infections of the biliary system with the formation of stones and strictures. The management aims are to treat acute cholangitis, clear the biliary ductal debris and calculi, and eliminate predisposing factors of bile stasis. Operative options include hepatectomy and biliary drainage procedures or a combination of both; nonoperative options include endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) guided procedures. This current study compares the operative and the nonoperative management outcomes in patients with RPC in 80 consecutive patients. In addition, we aim to evaluate our approach to the management of RPC over the past decade, according to the various degrees of severity and extent of the disease, and identify the patterns of recurrence in this complex clinical condition. Initial failure rate in terms of residual stone of operative compared with nonoperative treatment was 10.2% versus 32.3% ( ). Long-term failure rate for operative compared with non-operative treatment was 20.4% versus 61.3% ( ). Based on multivariate logistic regression, the only significant factors associated with failure were bilaterality of disease (OR: 8.101, ) and nonoperative treatment (OR: 26.843, ). The median time to failure of the operative group was 48 months as compared to 20 months in the nonoperative group ( ). Thus operative treatment is a durable option in long-term resolution of disease. Hepatectomy is the preferred option to prevent recurrent disease. However, biliary drainage procedures are also an effective treatment option. The utility of nonoperative treatment can achieve a reasonable duration of disease free interval with minimal complications, albeit inferior to operative management. 1. Introduction Recurrent pyogenic cholangitis (RPC) was first recognized as a distinct clinical entity in the 1930s by Digby [1]. He recognized that intrahepatic biliary calculus occurred more frequently in Hong Kong Chinese as compared to Europeans. In the 1950s, Cook proposed the subsequent term “recurrent pyogenic cholangitis” to describe the condition as a repeated infection of the biliary system with the formation of biliary stones and strictures in the biliary system [2]. Repeated infections of the biliary system have been implicated as one of the important causes of disease progression resulting in complications like biliary cirrhosis and cholangiocarcinoma [3, 4]. The therapeutic goals for the management of recurrent pyogenic cholangitis should
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