Surgical Experiences with Hepatectomy for Intrahepatic Stones

Park, Soon Do; Keum, Jae Wha; Lee, Sang Mok; Park, Ho Chul; Koh, Suk Hwan; Yoon, Choong; Hong, Sung Wha

Abstract

PURPOSE
Biliary stones, situated in the proximal sites from the confluence level of the right and left main bile ducts, are considered to be intrahepatic stones. Synonyms include hepatolithiasis and recurrent pyogenic cholangitis. The exact etiology of this condition is unknown, but it causes serious problems, such as obstructive jaundice, cholangitis and liver abscesses and so on. Hepatic resection is the treatment of choice for intrahepatic stones. With improving techniques in hepatobiliary surgery and aggressive surgical treatment, the outcome of intrahepatic stones has improved. The aim of this study was to evaluate the clinical outcomes after a hepatectomy for intrahepatic stones. METHODS: 77 patients underwent hepatic resections due to intrahepatic stones at the Department of Surgery, Kyung-Hee University between January 1996 and December 2002. The surgical outcome and follow-up were analyzed by a retrospective clinical review. RESULTS: The gender ratio of the patients was 1: 1.9 male to female, with a mean age of 54-years. The most common preoperative symptom was RUQ pain (81.8%). Concomitant diseases were common bile duct stones (53.2%), gallstones (23.4%), liver abscesses (7.8%), malignant neoplasms (6.5%) and choledochal cysts (5.2%). Nineteen patients (24.7%) had a history of cholecystectomy and 2 (2.6%) had had a hepatectomy at other hospitals due to intrahepatic stones. The stone locations were the right hemi-liver 18.2%, the left hemi-liver 66.2%, especially the left lateral section 44.2%, and bilaterally 15.6%. The operation methods were as follows; a right hemihepatectomy in 11 patients (14.3%), a posterior sectionectomy in 3 (3.9%), a left hemihepatectomy in 14 (18.2%), a lateral sectionectomy in 42 (54.5%), segmental resections at both lobes in 7 (9.1%) and biliary-enteric bypass in 24 (31.2%). The most common complication was wound infection (26.0%). Two patients had remaining stones and 1 had recurrent stones 4 years later. The morbidity and mortality were 42.9 and 1.3%, respectively. With a mean follow-up period of 49.6 months, 59 patients (76.6%) were free of symptoms. 15 patients (19.5%) had mild to moderate RUQ discomfort or pain, but no detectable stones on radiological studies. 3 patients (3.9%) needed admission for severe symptoms, one due to recurrent stones, but the others had no abnormal findings. CONCLUSION: There was low mortality, despite the high complication rates with hepatic resections for intrahepatic stones. Low rates of remaining stones and recurrence of intrahepatic stones can be achieved.