Original scientific articleSurgical Therapy for Hepatolithiasis: A Western Experience
Section snippets
Methods
From May 1986 to December 2003, 22 patients underwent surgical therapy for hepatolithiasis. A multicenter, retrospective analysis was performed. The number of patients per year is presented in Figure 2. Patient followup was obtained from hospital charts, office records, letter, or telephone contact. Gender, age, preoperative bilirubin levels, prothrombin time and CEA, preoperative comorbid medical disease, localization of stones, congenital anatomic alterations, diagnostic workup, previous
Preoperative clinical data
Preoperative clinical data are shown in Table 1. All of the patients were Caucasian. There was a predominance of male patients (59.1% versus 40.9%); median age was 56.68 ± 10.18 (range 33 to 71) years.
Six (27.3%) patients had comorbid illnesses such as hypertension5 and diabetes mellitus.3 One patient was hepatitis B surface antigen-positive, two patients were hepatitis C virus-positive, and one was an alcoholic. Mean preoperative level of bilirubin was 3.61 ± 4.18 (range 0.40 to 19.20) mg/dL,
Discussion
Surgical therapy has to be considered an effective and safe approach for hepatolithiasis, with low morbidity. The first question is the “timing” of the surgical intervention. Sepsis caused by cholangitis or liver abscess in patients with intrahepatic stones can usually be controlled with antibiotics combined with endoscopic or percutaneous drainage if necessary. In this series, patients had low mean preoperative levels of bilirubin, and all of them were in good general condition at the time of
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2021, Asian Journal of SurgeryCitation Excerpt :A better understanding of the therapeutic impact of hepatectomy associated with bile duct exploration and biliary drainage for intrahepatic lithiasis is necessary. Recurrence of symptoms revealed that bilioenteric anastomosis is not the ideal solution for intrahepatic lithiasis.23,30–32 Biliary fistula was the most common complication in the present study (13.3%) and infectious complications were observed in 13 patients (10.2%), related mainly to biliary fistula and previous cholangitis.
Chapter 39 - Intrahepatic stones
2016, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionCholedochoscopic lithotripsy is a useful adjunct to laparoscopic common bile duct exploration for hepatolithiasis: A cohort study
2016, American Journal of SurgeryCitation Excerpt :Hepatectomy is most often indicated for the treatment of unilateral hepatolithiasis and especially for left lobe stones and is rarely indicated for patients with right lobe stones and bilateral hepatic stones.3 Whether hepatic resection should be performed on patients without liver atrophy is still controversial, particularly when intrahepatic ducts are packed with stones but the liver is grossly normal or the stones are distributed bilaterally.11,13,14 In our department, it is generally agreed that patients with the following conditions are not candidates for liver resection: right localized and bilateral hepatolithiasis without atrophy, intrahepatic duct stricture associated with diffuse stones without atrophy, and coexisting biliary cirrhosis.
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Competing Interests Declared: None.