Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?
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.
Herman
Paulo
P
Department of Gastroenterology, Hospital Das Clínicas-University of São Paulo Medical School, São Paulo, SP, CEP 05403-000, Brazil. pherman@uol.com.br
Perini
Marcos V
MV
Pugliese
Vincenzo
V
Pereira
Julio Cesar
JC
Machado
Marcel Autran C
MA
Saad
William A
WA
D'Albuquerque
Luiz A C
LA
Cecconello
Ivan
I
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