Intraoperative biliary exploration through the left hepatic duct orifice during left hepatectomy in patients with left-sided hepatolithiasis.
OBJECTIVE
Left-sided hepatolithiasis often requires left hepatectomy and exploration of the common bile duct and right hepatic duct. The aim of this study was to assess the feasibility of alternative method of bile duct exploration other than choledochotomy.


METHODS
A prospective study involving 50 cases of left hepatectomy for left or bilateral intrahepatic stone was performed. Left hepatic duct (LHD) orifice was used as primary access route for biliary exploration. Choledochotomy was performed only for large common bile duct stones, variant bile duct anatomy, or intentional T-tube insertion for later removal of residual stones.


RESULTS
In 44 patients with left-sided hepatolithiasis, biliary exploration through LHD orifice was performed in 40 (90.9%); T-tube choledochotomy was required in three (9.1%). There was neither residual stone nor major surgical complication except infection, and recurrence occurred in one patient during mean follow-up of 32 months. On the other hand, T-tube choledochotomy was performed in three of six patients with bilateral hepatolithiasis (50%). Three patients had residual stones, and two of them were treated by cholangioscopy through the T-tube tract. Recurrence occurred in two patients.


CONCLUSIONS
We think that intraoperative biliary exploration through LHD orifice in left-sided hepatolithiasis patients is an effective approach simplifying the operation procedure by avoiding choledochotomy and subsequent T-tube insertion.
Hwang
Shin
S
Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. shwang@amc.seoul.kr
Lee
Sung-Gyu
SG
Kim
Myung-Hwan
MH
Lee
Sung-Koo
SK
Ahn
Chul-Soo
CS
Kim
Ki-Hun
KH
Lee
Young-Joo
YJ
D000328:Adult; D000368:Aged; D001284:Atrophy; D002758:Cholangiography; D002780:Cholestasis, Intrahepatic / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence