Indication and procedure for treatment of hepatolithiasis.
OBJECTIVE
Because of its complicated clinicopathologic features, hepatolithiasis is difficult to treat, and there is no established method of treating patients with intrahepatic stones.


METHODS
Retrospective case-control study.


METHODS
Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan (January 1, 1971-December 31, 2000).


METHODS
Eighty-nine patients treated for hepatolithiasis (43 male; median age, 56.9 years).


METHODS
The rate of residual stones and complications after the treatments of hepatolithiasis.


RESULTS
Between 1971 and 1985, 17 patients (41%) had stones located in the left or right intrahepatic duct, and 25 patients (60%) had stones located in the bilateral intrahepatic duct. From 1986 through 2000, 32 patients (68%) had stones located in the left or right intrahepatic duct, and 15 patients (32%) had stones located in the bilateral intrahepatic duct (P =.009). The rate of residual stones after surgical and nonsurgical treatment was 41% (17 of 42 patients) in 1971 through 1985, but decreased to 11% (5 of 47 patients) in 1986 through 2000 (P =.001). The rate of residual stones after cholangioenterostomy or T-tube insertion was 43.8% (21 of 48 patients), but the rate of residual stones after hepatectomy or percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) was 2.4% (1 of 41 patients, P<.001). In cases treated by PTCSL, we used a holmium (Ho):YAG laser in 3 cases since 1999. To our knowledge, there have been no reports describing the use of Ho:YAG lasers to treat hepatolithiasis. Also, board-shaped stones can be sufficiently pulverized without inducing hemorrhage from the bile duct wall.


CONCLUSIONS
According to the current therapeutic strategy for hepatolithiasis, hepatectomy seems to be the most effective treatment for selected patients with isolated left hepatolithiasis if other surgical procedures cannot remove all the related lesions. In addition, PTCSL seems to be performed first in isolated right hepatolithiasis and bilateral lobe type hepatolithiasis. In PTCSL procedures, favorable results have been obtained using the Ho:YAG laser for fracturing intrahepatic stones.
Uchiyama
Kazuhisa
K
Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Onishi
Hironobu
H
Tani
Masaji
M
Kinoshita
Hiroyuki
H
Ueno
Masaki
M
Yamaue
Hiroki
H
D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053685:Laser Therapy; D020347:Lithiasis / Q000601:surgery*; D008096:Lithotripsy; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome