title: Indication and procedure for treatment of hepatolithiasis.
abstract: 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.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Hironobu
authors.initials: H
authors.lastname: Onishi
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: 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