title: Anatomic hepatectomy as a definitive treatment for hepatolithiasis: a cohort study.
abstract: BACKGROUND
  Treatment requirements in hepatolithiasis may vary and may involve a multidisciplinary approach. Surgical resection has been proposed as a definitive treatment.
  
  
  OBJECTIVE
  This study aimed to evaluate the clinical results of anatomic liver resection among Chilean patients with hepatolithiasis.
  
  
  METHODS
  An historical cohort study was conducted. Patients who underwent hepatectomy as a definitive treatment for hepatolithiasis from January 1990 to December 2010 were included. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded. Preoperative, operative and postoperative variables were evaluated.
  
  
  RESULTS
  A total of 52 patients underwent hepatectomy for hepatolithiasis. The mean ± standard deviation patient age was 49.8 ± 11.8 years (range: 24-78 years); 65.4% of study subjects were female. A total of 75.0% of subjects had a history of previous cholecystectomy. The main presenting symptom was abdominal pain (82.7%). Hepatic involvement was noted in the left lobe in 57.7%, the right lobe in 34.6% and bilaterally in 7.7% of subjects. The rate of postoperative clearance of the biliary tree was 90.4%. Postoperative morbidity was 30.8% and there were no postoperative deaths. Three patients had recurrence of hepatolithiasis, which was associated with Caroli's disease in two of them. Overall 5-year survival was 94.5%.
  
  
  CONCLUSIONS
  Anatomic liver resection is an effective treatment in selected patients with hepatolithiasis and is associated with low morbidity and no mortality. At longterm follow-up, anatomic hepatectomy in these patients was associated with a lower rate of recurrence.
authors.affiliation: Department of Digestive Surgery, Pontifical Catholic University of Chile, Santiago, Chile. njarufe@med.puc.cl
authors.forename: Nicolás
authors.initials: N
authors.lastname: Jarufe
authors.forename: Eduardo
authors.initials: E
authors.lastname: Figueroa
authors.forename: César
authors.initials: C
authors.lastname: Muñoz
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Moisan
authors.forename: Julian
authors.initials: J
authors.lastname: Varas
authors.forename: José R
authors.initials: JR
authors.lastname: Valbuena
authors.forename: Claudia
authors.initials: C
authors.lastname: Bambs
authors.forename: Jorge
authors.initials: J
authors.lastname: Martínez
authors.forename: Fernando
authors.initials: F
authors.lastname: Pimentel
mesh_terms: D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D001706:Biopsy; D016767:Caroli Disease / Q000150:complications; D016009:Chi-Square Distribution; D002677:Chile; D002763:Cholecystectomy / Q000009:adverse effects; D002769:Cholelithiasis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult