Surgical Management of Intrahepatic Stone

Cho, Sung Oh; Lee, Yeoung Taeg; Park, Yong Ki; Choi, Chang Rock

Abstract

Intrahepatic stones are found predominantly in southeast Asia and causes serious problems including obstructive jaundice, cholangitis, and liver abscesses. The operative principles for resolving these problems are complete removal of the stones within intrahepatic and extrahepatic ducts and establishment of adequate drainage. The clinical features and follow-up results of 90 patients with intrahepatic stones who were treated surgically at the Department of Surgery of St. Benedict Hospital during the period of 10 years from January 1987 to December 1996 are presented. This study includes all the gallstones located in the intrahepatic ducts above the confluence of the main hepatic ducts. Biliary bypass operations were performed in 30 cases (33%) with 29 biliojejunostomies and one choledochoduodenostomy. Five of the 29 hepaticojejunostomies had subcutaneous jejunal limb. Partial hepatectomies were performed in 20 cases (22%) with 16 left lateral segmentectomy and 4 of left hepatic lobectomies. The overall postoperative complication rate was 40%: 70% in the hepatic resection group and 31% in the non-hepatic resection group. The relative incidence of good results was higher in the hepatic resection group (68%) than in the non-hepatic resection group (41%) and in the biliary bypass operation group (54%) than in the non-biliary bypass operation group (41%). In conclusion, an aggressive hepatic resection with biliary bypass operation should be performed, if permitted, in patients with intrahepatic stones.