Non‐Oriental Primary Intrahepatic Lithiasis: Experience with 48 Cases

Abstract

Abstract. An experience with the diagnosis and treatment of patients with non-Oriental primary intrahepatic lithiasis (PIHL) is described. A group of 48 native Brazilian patients with symptomatic PIHL were studied, and the patientsÕ characteristics, diagnoses, treatment protocols based on the presentation of the disease, prognostic factors, and late results were analyzed. Liver resection was performed in patients with an irreversible lesion, such as parenchymal atrophy or biliary stenosis; and biliary drainage procedures were employed in patients with bilateral disease. Late results were considered good when no postoperative symptoms were observed and poor if there was pain recurrence or cholangitis. Overall good results were observed in 73.4% of the patients. Good late results were observed in 94.1% and 62.1% of the patients with unilateral and bilateral stones, respectively. None of the analyzed parameters (gender, age, previous biliary surgery, bilirubin level, serum leukocyte counts, prothrombin activity, previous history of cholangitis, stone location) predicted poor late results, but the risk for patients with bilateral stones to develop late complications was 7.2 times higher than for those with unilateral disease.Non-Oriental PIHL is a rare disease, and the patientsÕ characteristics are similar to those of patients with Oriental PIHL. We believe that personalized treatment based on the presentation of the disease led to the high incidence of good late results in this series.

Anatomic hepatectomy as a definitive treatment for hepatolithiasis: a cohort study

“…Hepatolithiasis has been defined as the occurrence of stones in any intrahepatic bile duct proximal to the confluence of the right and left hepatic ducts, irrespective of the presence of stones in the main bile duct or the gallbladder 1 . It is prevalent in Japan and Southeast Asia 2 and uncommon in Western countries 3,4 …”

Liver resection for intrahepatic stones in congenital bile duct dilatation

“…Indeed, the literature reports the risk of development of cancer in patients with intrahepatic lithiasis at 5.8 to 17% [17][18][19]. For this reason, liver resection has been increasingly used as a treatment for PIHL [4,5,7,[20][21][22]. Mabrut et al [4] recently reported the results of a multicenter study in which 27 patients underwent liver resection for localized disease with satisfactory results in 87% of cases.…”

“…Primary stone formation must be distinguished from gallstones due to stone migration from the gallbladder and from stone formation upstream from post-operative biliary strictures. PIHL is a very rare condition in Western countries (less than 1% of all gallstones) [4], but is more common in the Orient (about 4% of gallstones in Japan) [5]. Bile stasis and stone formation on the one hand and chronic inflammation and infection on the other result in progressive atrophy of the involved parenchyma and lead to dysplastic transformation of the biliary epithelium, which may result in the development of cholangiocarcinoma [6].…”

Liver Resection for Non-Oriental Hepatolithiasis

“…In secondary intrahepatic lithiasis, stones are originally formed in the gallbladder or common bile duct and then migrate to the liver. Intrahepatic lithiasis is more common in the left lobe possibly because an acute angle between the common hepatic duct and the left hepatic duct which could induce bile stasis 2 , 5 , 13 , 17 .…”