The treatment of isolated left-sided hepatolithiasis.
OBJECTIVE
It has been over 20 years since percutaneous transhepatic cholangioscopic lithotomy (PTCSL) or left lateral segmentectomy with postoperative cholangioscopy (POC) was applied in treating isolated left-sided hepatolithiasis (ILH). However, their efficacy in treating ILH is not elucidated clearly in the literature.


METHODS
A retrospective study was conducted in 59 patients with ILH undergoing either PTCSL or left lateral segmentectomy with POC during the past 22 years. The mean period of followup was 10.8 years (1-22 years).


RESULTS
Hepatolithiasis restricted in the left external hepatic duct (LEHD), whose stones can be cleared by left lateral segmentectomy without undergoing POC, was only found in 17% (10/59) of the patients with ILH. The overall complication rate of left lateral segmentectomy with POC was 22% (4/18), and of PTCSL was 17% (7/41). Either in patients with (82%, 9/11 vs. 71%, 12/17; p > 0.05) or without intrahepatic ducts (IHDs) stricture (100%, 7/7 vs. 92%, 22/24; p > 0.05) in the liver remnant, the rates of complete stone clearance were comparable between left lateral segmentectomy with POC and PTCSL. The stone recurrence rate and cumulative nonrecurrence rate in patients with IHDs stricture in the liver remnant were also comparable between left lateral segmentectomy with POC and PTCSL (p > 0.05). Nevertheless, hepatolithiasis did not recur in patients without IHD stricture in the liver remnant after left lateral segmentectomy with POC, whose stone recurrence rate was lower than those without (0%, 0/7 vs. 50%, 10/20; p = 0.026) or with (0%, 0/7 vs. 7/12, 58%; p = 0.017) IHDs stricture undergoing PTCSL. After undergoing left lateral segmentectomy with POC, the cumulative nonrecurrence rate was also higher in patients without IHDs stricture in the liver remnant than those with IHDs stricture in the liver remnant (p < 0.05).


CONCLUSIONS
Left lateral segmentectomy with POC and PTCSL have comparable efficacy in treating ILH. However, no stone recurs when ILH are completely removed without IHD stricture left in the liver remnant after left lateral segmentectomy with POC. The presence of IHDs stricture in the liver remnant is the major factor contributing to ILH recurrence after successful left lateral segmentectomy with POC.
Chen
Chien-Hua
CH
Digestive Disease Center, Department of Medical Research, Show-Chwan Memorial Hospital, Changhua, Taiwan. peach@show.org.tw
Huang
Min-Ho
MH
Yang
Jee-Chun
JC
Yang
Chi-Chieh
CC
Yeh
Yung-Hsiang
YH
Mo
Lien-Ray
LR
Wu
Hurng-Sheng
HS
Chou
Der-Aur
DA
Yueh
Sen-Kou
SK
Nien
Chiu-Kue
CK
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D020347:Lithiasis / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult