Treatment outcome of hepatolithiasis: Nepalese experience

Abstract

Background: Hepatolithiasis is a rare disease with high rate of treatment failure and recurrence. This study aims to review the burden, management and outcome from an endemic region.Methods: A retrospective review of database of patients with hepatolithiasis managed surgically from 2015 to 2019 was performed. Diagnosis was based on the clinical findings and radiological investigations. Demographic data, clinical presentation, extent of disease and type of surgical management were evaluated. The outcome measures included immediate stone clearance, postoperative complications and follow-up.Results: Hepatolithiasis was seen in nine (0.34%) out of 2,600 patients being evaluated for gallstone disease. Three patients were young, while the remaining six were in the middle-age group. The presenting symptoms were pain abdomen (78%) and jaundice (22%). Hepatolithiasis was located in the left, right and both ductal systems in 5, 1 and 3 patients respectively. Liver resection for unilateral disease was done in 3 patients: left hepatectomy (n=2) and left lateral segmentectomy (n=1). High bile duct exploration and bilio-enteric drainage was done in 5 patients. One patient required hepatolithotomy and T-tube drainage due to cholangitis. Complete stone clearance was achieved in 78%. Complications included surgical site infection and cholangitis in 2 patients. There was no operative mortality. Histopathology revealed recurrent pyogenic cholangitis. At median follow-up of 28 months, 7 patients are symptom-free.Conclusions: Hepatectomy is an effective treatment when disease is confined to the left lobe. Combined surgical procedure is an acceptable option for bilateral or right-sided hepatolithiasis.

Hepatolithiasis following hepaticojejunostomy successfully treated with right hepatectomy: A case report.

“…Even though cases of hepatolithiasis are common in South Asia compared to western world, rarely cases are reported from Nepal. 2 A retrospective study conducted in a tertiary care centre of Nepal showed 0.34% prevalence of hepatolithiasis among biliary surgeries 7 . Hepatolithiasis has variety of presenting complains ranging from abdominal pain to cholangitis-like features or it can be found incidentally as reported in our case.…”

Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal

“…It is similar to that observed by Pandit N et al in their study. 8 This early age at presentation of hepatolithiasis may be because of low socioeconomic conditions, malnutrition and recurrent subclinical infections of the biliary tree. 1 Hepatolithiasis was found to occur more frequently in left liver (50%) in our study.…”