The significance of hepatectomy for primary intrahepatic stones

Abstract

The objective of this study was to evaluate the significance of performing hepatectomy for primary intrahepatic stones. Observations on the morphology of the bile ducts, histopathological findings of the excised liver, and treatment results were reviewed in 29 of 35 patients with primary intrahepatic stones. The remaining 6 patients (17.1%) were excluded because they had intrahepatic cholangiocarcinoma. The subjects were classified into two groups according to the morphological characteristics of the bile ducts; one group comprised 25 patients having strictures in the central bile duct, and another group comprised 4 patients having no biliary stricture, but a localized dilatation in the distal bile duct. Calcium bilirubinate stones were found in all the patients with a biliary stricture, whereas cholesterol stones were found in those without a biliary stricture. Hepatectomy was performed in 25 of the 29 patients (86.2%), the results of which were excellent. In fact, during the past 10 years, no postoperative complications have occurred, nor have there been any retained or recurrent stones. Moreover, the postoperative hospitalization period was as short as 15.3 days. The findings of this study indicate that hepatectomy allows treatment for primary intrahepatic stones to be completed within a short period of time without incurring serious postoperative complications, and serves as a useful prophylactic technique for recurrent stones.

Liver Resection for Primary Intrahepatic Stones

“…Indeed, cholangiocarcinoma is reported as a consequence of epithelial changes caused by stones and inflammation. 2,3 Cholangiocarcinoma was found in 3 of 35 patients (8.6%) in our series; it remained undiagnosed before admission (in 2 cases even before surgery), and in 2 patients it caused death within 6 months. The risk of development of cancer cannot be predicted from the duration or the clinical history of the disease because cancer may also be the first presenting symptom.…”

Resección hepática en el tratamiento de la litiasis intrahepática: Resultados inmediatos y a largo plazo en una serie occidental

“…En los países occidentales la LIH es poco frecuente y suele ser secundaria a un empedrado de la vía biliar principal y posterior migración de los cálculos al interior del hígado. Existen cálculos de formación primaria intrahepática (12,15,26,27) debidos a: enfermedad de Caroli, colangitis esclerosante, colangiocarcinoma, estenosis biliares postraumáticas o postquirúrgicas, etc. En nuestra serie, los cálculos se formaron a nivel intrahepáti-co de forma primaria en 3 casos, los cuales padecían una enfermedad de Caroli.…”

“…Este último puede efectuarse bajo control radioló-gico percutáneo (colangioscopia transhepática percutánea, abordaje a través del tubo en T y otras) o endoscópico con o sin litroticia asociada (3,12,16,29,31,32). El tratamiento quirúrgico de los cálculos se puede realizar a través de una (4,(5)(6)(7)(8)12,15,17,19,24,26,27,(33)(34)(35).…”

Intraoperative biliary exploration through the left hepatic duct orifice during left hepatectomy in patients with left-sided hepatolithiasis

“…Thus, the primary aim of hepatolithiasis treatment is long-term prevention of recurrence and management of associated complications [5][6][7][8]. Surgical risk associated with hepatectomy has markedly diminished over the last decade due to technical advances and improvement in perioperative care [4,11]. Thus, liver resection has become the established standard primary treatment for unilobar hepatolithiasis, as it enables removal of both the biliary stenoses and the stones [5].…”

“…Primary hepatolithiasis shows diverse features in terms of pathogenesis, clinical manifestation, and treatment [1][2][3][4][5][6]. While a common disease in East Asia [7][8][9], it is rare in other areas of the world [10].…”