Hepatectomy for bilateral primary hepatolithiasis: a cohort study.
OBJECTIVE
This study aimed to evaluate the perioperative and long-term results of partial hepatectomy for patients with complicated bilateral primary hepatolithiasis.


BACKGROUND
Hepatolithiasis is best managed by a multidisciplinary approach. Definitive treatment can be offered using endoscopic, percutaneous, laparoscopic, or open surgical approaches. Partial hepatectomy is only indicated for recurrent, troublesome, localized, and severe disease affecting the liver.


METHODS
From January 2000 to December 2006, 136 consecutive patients who underwent bilateral (n = 54) or unilateral (n = 82) hepatectomy for biliary strictures and bilateral primary hepatolithiasis in our center were included in this study. All patients had concomitant bile duct exploration. Their perioperative and long-term outcomes were analyzed.


RESULTS
The immediate stone clearance rates after bilateral and unilateral hepatectomy were 81.5% and 65.9%, respectively. Additional postoperative choledochoscopic lithotripsy raised the clearance rates to 85.2% and 81.7%, respectively. The hospital mortality rates were 5.6% and 0%, respectively, and the complication rates were 46.3% and 46.3%, respectively. The 5-year overall survival rates were 98% and 91.5%, respectively.


CONCLUSIONS
In selected patients with biliary strictures and bilateral hepatolithiasis, partial hepatectomy associated with choledochoscopic lithotripsy is a safe and efficacious treatment, with a high immediate stone clearance rate, a low long-term stone recurrence rate and good long-term survival.
Yang
Tian
T
Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Lau
Wan Yee
WY
Lai
Eric C H
EC
Yang
Li-Qun
LQ
Zhang
Jin
J
Yang
Guang-Shun
GS
Lu
Jun-Hua
JH
Wu
Meng-Chao
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002648:Child; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery; D002780:Cholestasis, Intrahepatic / Q000473:pathology / Q000601:surgery; D006498:Hepatectomy; D006500:Hepatic Duct, Common; D006801:Humans; D020347:Lithiasis / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055815:Young Adult