Liver resection for intrahepatic stones.
OBJECTIVE
Long-term outcome is good for a selected group of patients with hepatolithiasis treated with liver resection. Liver resection should also be offered to patients with complex hepatolithiasis such as bilateral stones or those with strictures.


METHODS
Retrospective study.


METHODS
Regional hospital.


METHODS
A total of 174 patients with hepatolithiasis (201 procedures) treated between January 1, 1989, and September 30, 2003.


METHODS
Liver resection (52 procedures) or removal of stones primarily by percutaneous choledochoscopy (149 procedures).


METHODS
Recurrence of cholangitis.


RESULTS
Most patients in the liver resection group had stones localized to the left side. The overall success rate in this group was 98.0% (49 of 50 patients, excluding 2 patients found to have cholangiocarcinoma). The chance of biliary sepsis at 5 years after resection was 13.3%. The overall success rate of stone removal primarily by percutaneous choledochoscopy was 70.5%. The bilaterality of stones, the presence of stricture, and the presence of atrophy were found to be significant risk factors for a poor long-term outcome after stone removal alone. The chance of biliary sepsis at 5 years was 26.4% and 43.2% for those without and with stricture, respectively.


CONCLUSIONS
The long-term outcome after liver resection for hepatolithiasis was excellent for a selected group of patients. Poor outcomes were recorded for patients whose intrahepatic stones were removed primarily by percutaneous choledochoscopy, especially those with strictures. The indication for liver resection for hepatolithiasis should be extended to patients with strictures and those with bilateral stones. A combination of different treatment modalities is necessary to improve the outcome of these patients.
Cheung
Moon-Tong
MT
Department of Surgery, Queen Elizabeth Hospital, Gascoigne Road, Kowloon, Hong Kong. qehsurg@ha.org.uk
Kwok
Philip Chong-Hei
PC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy; D006801:Humans; D020347:Lithiasis / Q000150:complications / Q000601:surgery*; D008107:Liver Diseases / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome