Right Hepatic Lobectomy in the Treatment of Right-sided Hepatolithiasis

Hwang, Shin; Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Choi, Dong Rak; Kim, Ki Hoon; Min, Pyung Chul

Abstract

BACKGROUND: Right-sided hepatolithiasis has been diagnosed in 14-25% of all hepatolithiasis cases and right hepatic resection contributes only 5-9% of all hepatic resections for hepatolithiasis. Outcomes of otherwise treatment modalities were unsatisfactory resulting high incidence of remnant stone and high recurrence rate. General indications for hepatic resection in hepatolithiasis include localized intrahepatic calculi with irreversible biliary strictures, atrophied segment or lobe of the liver, multiple cholangitis abscess and possible presence of cholangiocarcinoma. PURPOSE: In this study, we presented the outcome of right hepatic lobectomy in right-sided hepatolithiasis patients, especially focused on the rationale and indications of this procedure.
METHODS
We reviewed 15 cases undergone right lobectomy for right-sided hepatolithiasis from January 1995 to June 1997 with median follow-up of 23 months.
RESULTS
Mean age of the patients was 49 years old. Clinical manifestations included signs of cholangitis in 7 (47%), abdominal pain in 5 (33%), jaundice in 1 (7%) and nonspecific symptoms in 2 (13%) cases. Criteria for indications of right lobectomy were overt biliary strictures in 9 (60%), marked atrophy of the right lobe in 7 (47%), multiple cholangitis abscess in 6 (40%) and suspected cholangiocarcinoma in 2 (13%) cases. Mean indocyanine green retention rate at 15 minutes was 7.6 4.5% and mean weight of resected specimen was 352 185 gm. Operative stone clearance rate was 100% for 14 isolated right-sided hepatolithiasis cases and choledochoscopic stone removal was followed for 1 both-sided case. Overall stone clearance rate was also 100%. Rate of stone recurrence was 0% at median follow-up of 23 months. Operative complications occurred in 4 cases without hepatic function-associated complication or operative mortality.
CONCLUSIONS
Right hepatic lobectomy is indicated in patients who have localized right-sidedhepatolithiasis with irreversible biliary strictures involving the right hepatic duct, an atrophied right lobe of the liver, multiple cholangitis abscesses, or possible presence of cholangiocarcinoma.