Partial Liver Resection in Hepatolithiasis

Han, Seh Wan; Lee, Myung Soo; Kim, Kyung Whan; Kim, Hong Joo; Kim, Young Duck; Kim, Hong Yong

Abstract

Patients with hepatolithiasis have complicated clinical features. Many patients have bilobar involvement and biliary strictures at multiple levels are frequently observed. Treatment of hepatolithiasis should be individualized according to the underlying condition. We reviewed the therapeutic results for hepatolithiasis in 81 patients. Forty-three patients (53.1%) underwent partial resection of the liver, and 38 received non-resectional treatment. Abdominal pain in the right upper quadrant was the most common symptom and history of cholangitis was confirmed in 24 patients (29.6%). Intrahepatic stones were located in the left side of the liver in 40 patients, and 31 patients had stones in both sides of the liver. Left lateral segmentectomy was the most commonly used operation (n=31); other types of hepatic resection were segmentectomy of the right lobe (n=8), left lobectomy (n=3), and right lobectomy (n=1). For the drainage of the biliary outflow, we carried out hepaticojejunostomy with subcutaneous jejunostomy in 14 patients and choledochoduodenostomy in 8 patients. All patients underwent cholangiography and percutaneous choledochoscopic examination post-operatively to confirm the absence of residual stones. Residual stones were detected in 8 patients (6 with biliary drainage alone, 2 with hepatic resection). There was no operation-related mortality. The mean value of the operative time was longer in the patients receiving hepatic resection (216 min. versus 187 min.). There were no significant differences in terms of post-operative complications (6 with biliary drainage alone, 8 with hepatic resection) or hospital stay between the patients who received hepatic resection and those who received non-resectional treatment. In conclusion, partial resection of a diseased liver is an effective treatment for hepatolithiasis in selected patients and does not increase peri-operative morbidities.