Reducing residual and recurrent stones by hepatectomy for hepatolithiasis.
The long-term outcomes of 97 consecutive patients with hepatolithiasis, who underwent treatment from January 1971 to June 2006, were analyzed. The short-term outcomes included the rate of residual stones and complications after treatment, whereas the long-term results included the stone recurrence rate. In 22 of the 97 (22.7%) patients, residual stones were found after treatment for hepatolithiasis. The incidence of residual stones was 0% in hepatectomy patients, 48.6% in cholangioenterostomy patients (p < 0.001, compared with hepatectomy), 25.0% in T-tube drainage patients (p = 0.015, compared with hepatectomy), and 10.0% in percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) patients. In 15 of the 66 (22.7%) patients who were treated for hepatolithiasis, recurrent stones were found after intervals of 5 to 24 years. The incidence of recurrent stones was 13.9% in hepatectomy patients, 28.5% in cholangioenterostomy patients, 25.0% in T-tube drainage patients, and 50.0% in PTCSL patients (p = 0.021, compared with hepatectomy). Hepatectomy appears to be the most effective treatment for selected patients with isolated left hepatolithiasis (L). In PTCSL procedures, favorable results have been obtained when the stones were completely cleared; however, the incidence of recurrent stones is high in patients after PTCSL.
Uchiyama
Kazuhisa
K
Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Kawai
Manabu
M
Ueno
Masaki
M
Ozawa
Satoru
S
Tani
Masaji
M
Yamaue
Hiroki
H
D000328:Adult; D000368:Aged; D002768:Choledochostomy / Q000009:adverse effects; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007440:Intubation / Q000009:adverse effects / Q000295:instrumentation; D020347:Lithiasis / Q000601:surgery* / Q000628:therapy; D008096:Lithotripsy / Q000009:adverse effects; D008107:Liver Diseases / Q000601:surgery* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome