Liver transplantation for patients with hepatolithiasis.
BACKGROUND
Because of its complicated pathological features such as repeated cholangitis and multiple operations, hepatolithiasis is difficult to treat and often lead to portal hypertension, and liver failure. The aim of this study was to investigate the indications of orthotopic liver transplantation (OLT)for patients with hepatolithiasis and the improvement of operative techniques and the treatment of postoperative complications.


METHODS
The data of 4 patients with hepatolithiasis who had undergone OLT at our department in recent years were reviewed retrospectively.


RESULTS
The 4 patients with hepatolithiasis complicated with secondary biliary cirrhosis in end-stage liver disease included 1 woman and 3 men. One patient underwent OLT using veno-venous bypass prior to the mobilization of the liver. Two patients were subjected to liver transplantation with improved piggyback technique without bypass. One patient received OLT without bypass. All patients were operated on successfully and recovered uneventfully. Patient 1 had bleeding from the digestive tract on the postoperative day 6. Patient 2 had hemorrhage from the digestive tract and a leakage of end-to-side intestinal anastomosis on the postoperative day 44. Patient 4 was reoperated on because of hemorrhage from the anastomotic stoma of the hepatic artery on the postoperative days 8 and 10. In the 4 patients the mean operative time was 7.9 hours and blood loss was 910 ml. Postoperative pathological analysis revealed biliary liver cirrhosis. Follow-up of all patients showed good conditions.


CONCLUSIONS
Hepatolithiasis with secondary biliary liver cirrhosis in patients with end-stage liver disease is indicated for liver transplantation. Veno-venous bypass prior to the mobilization of the liver and improved piggyback technique can lower the incidence of intraoperative bleeding, the duration of surgery and postoperative complications.
Pan
Guang-Dong
GD
Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China. pgdhx@126.com
Yan
Lu-Nan
LN
Li
Bo
B
Lu
Shi-Chun
SC
Zeng
Yong
Y
Wen
Tian-Fu
TF
Zhao
Ji-Chun
JC
Cheng
Nan-Sheng
NS
Ma
Yu-Kui
YK
Wang
Wen-Tao
WT
Yang
Jia-Yin
JY
Li
Zhi-Hui
ZH
D000328:Adult; D000368:Aged; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications; D017093:Liver Failure / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome