Hepatolithiasis: a Turkey experience.
OBJECTIVE
The aim of this study was to report our experience of hepatolithiasis, diagnosed in 55 patients between June 1995 and March 2003.


METHODS
Fifty-five patients who underwent endoscopic retrograde cholangiopancreatography for hepatolithiasis between June 1995 and March 2003 at our institution were evaluated. Diagnosis of hepatolithiasis was based on cholangiography, ultrasonography and computed tomography. Patients with hepatolithiasis were classified according to Tsunoda classification.


RESULTS
Fifty-five patients with hepatolithiasis (22 female, 33 male; mean age: 48.2 +/-14.9, range: 22-83) were included in this study. The major causes of hepatolithiasis were previous bilio-digestive surgery and Caroli disease, with rates of 49% and 14.5%, respectively. While 37 of 55 patients (67.3%) presented with only intrahepatic lithiasis, 18 patients (32.7%) had intrahepatic lithiasis associated with common bile duct (16/18, 29%) or gallbladder (2/18, 3.6%) stones. According to Tsunoda classification, 4 patients were classified as type I, 32 type II, 9 type III and 10 type IV. Patients with types I and II had significantly better stone clearance rates in comparison to those with types III and IV (p<0.05). Complete eradication of stones in the patients with proximal strictures was significantly lower than in the patients with distal strictures (p<0.01). While complete clearance of stones was achieved in 22 cases (40%), incomplete clearance was achieved in 17 cases (30.9%) with endoscopic retrograde cholangiopancreatography . Mean number of endoscopic retrograde cholangiopancreatography procedures for clearance of stones was 4 (ranges: 1-9).


CONCLUSIONS
The etiology of hepatolithiasis in our patients is similar to that observed in Western populations and endoscopic approach appears to be an effective alternative to surgery.
Kayhan
Burçak
B
Department of Gastroenterology, Ankara Numune Education and Training Hospital, Ankara. burkaygastro@hotmail.com
Akdoğan
Meral
M
Parlak
Erkan
E
Ozarslan
Ersan
E
Sahin
Burhan
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016767:Caroli Disease / Q000150:complications; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000150:complications; D003952:Diagnostic Imaging; D005260:Female; D042882:Gallstones / Q000150:complications; D006801:Humans; D020347:Lithiasis / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D008107:Liver Diseases / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014421:Turkey; D055815:Young Adult