title: Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?
abstract: OBJECTIVE
  To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis. Prognostic factors, especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed.
  
  
  METHODS
  Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection. Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of the extrahepatic biliary duct (> 2 cm). Late results and risk factors for recurrence of symptoms or stones were evaluated.
  
  
  RESULTS
  There was no operative mortality. After a mean follow-up of 50.3 mo, good late results were observed in 82.9% of patients; all patients submitted to liver resection alone and 58.8% of those submitted to liver resection and hepaticojejunostomy were free of symptoms (P = 0.0006). Patients with unilateral and bilateral disease showed good late results in 94.1% and 28.6%, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Recurrence of symptoms in patients with hepaticojejunostomy showed that this may not be the ideal solution. Further studies are needed to establish the best treatment for patients with bilateral stones or unilateral disease and a dilated extrahepatic duct.
authors.affiliation: Department of Gastroenterology, Hospital Das Clínicas-University of São Paulo Medical School, São Paulo, SP, CEP 05403-000, Brazil. pherman@uol.com.br
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.forename: Marcos V
authors.initials: MV
authors.lastname: Perini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pugliese
authors.forename: Julio Cesar
authors.initials: JC
authors.lastname: Pereira
authors.forename: Marcel Autran C
authors.initials: MA
authors.lastname: Machado
authors.forename: William A
authors.initials: WA
authors.lastname: Saad
authors.forename: Luiz A C
authors.initials: LA
authors.lastname: D'Albuquerque
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020347:Lithiasis / Q000517:prevention & control / Q000601:surgery*; D008099:Liver / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D008107:Liver Diseases / Q000517:prevention & control / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult