Original scientific article
Surgical Therapy for Hepatolithiasis: A Western Experience

https://doi.org/10.1016/j.jamcollsurg.2005.09.022Get rights and content

Background

Hepatolithiasis is very common in East Asia but infrequent in Western countries, and few reports have been published in European series. In East Asia, the association between cholangiocarcinoma and hepatolithiasis is well recognized, but, on the contrary, hepatolithiasis is uncommon in Europe and the United States, and the relationship with cholangiocarcinoma is not well established. The goal of this study was to analyze the perioperative and longterm results of surgical therapy for hepatolithiasis.

Study design

Record review of 22 patients was done to locate immediate (operative morbidity and mortality) and longterm (stone recurrence and survival) results of patients with hepatolithiasis who underwent surgical treatment.

Results

There were 19 (86.4%) hepatic resections and 10 (45.5%) hepaticojejunoanastomoses. Operative mortality was absent and morbidity rate was 27.3%. Right hepatectomy was predictive of postoperative complications at multivariate analysis (p = 0.04). One (4.5%) patient had an unknown associated cholangiocarcinoma at time of surgical intervention. Mean followup was 67.59 ± 65.67 (range 12 to 215) months. None presented recurrent cholangitis during the followup period.

Conclusions

Surgical therapy is a safe and effective management for hepatolithiasis. The possibility of developing cholangiocarcinoma in inveterate hepatolithiasis is real, and hepatic resection removes this risk.

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

References (22)

  • G.L. Grazi et al.

    Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre

    Aliment Pharmacol Ther

    (2004)
  • Cited by (52)

    • Surgical resection for non-Asian intrahepatic lithiasis: The Brazilian experience

      2021, Asian Journal of Surgery
      Citation 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 Edition
    • Choledochoscopic lithotripsy is a useful adjunct to laparoscopic common bile duct exploration for hepatolithiasis: A cohort study

      2016, American Journal of Surgery
      Citation 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.

    View all citing articles on Scopus

    Competing Interests Declared: None.

    View full text