Liver Resection for Primary Intrahepatic Stones: Focus on Postoperative Infectious Complications.
BACKGROUND
Primary intrahepatic lithiasis is defined by the presence of gallstones at the level of cystic dilatations of the intrahepatic biliary tree. Liver resection is considered the treatment of choice, with the purpose of removing stones and atrophic parenchyma, also reducing the risk of cholangiocarcinoma. However, in consequence of the considerable incidence of infectious complications, postoperative morbidity remains high. The current study was designed to evaluate the impact of preoperative bacterial colonization of the bile ducts on postoperative outcome.


METHODS
The clinical records of 73 patients treated with liver resection were reviewed and clinical data, operative procedures, results of bile cultures, and postoperative outcomes were examined.


RESULTS
Left hepatectomy (38 patients) and left lateral sectionectomy (19 patients) were the most frequently performed procedures. Overall morbidity was 38.3 %. A total of 133 microorganisms were isolated from bile. Multivariate analysis identified previous endoscopic or percutaneous cholangiography (p = 0.043) and preoperative cholangitis (p = 0.003) as the only two independent risk factors for postoperative infectious complications.


CONCLUSIONS
Postoperative morbidity was strictly related to the preoperative biliary infection. An effective control of infections should be always pursued before liver resection for intrahepatic stones and an aggressive treatment of early signs of sepsis should be strongly emphasized.
Hepatobiliary Unit, Department of Surgical Sciences, A. Gemelli Medical School, Largo Gemelli, 800168, Rome, Italy. gclemente@rm.unicatt.it.
Gennaro
G
Clemente
Hepatobiliary Unit, Department of Surgical Sciences, A. Gemelli Medical School, Largo Gemelli, 800168, Rome, Italy.
Agostino M
AM
De Rose
Department of Infectious Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, Rome, Italy.
Rita
R
Murri
Hepatobiliary Unit, Department of Surgical Sciences, A. Gemelli Medical School, Largo Gemelli, 800168, Rome, Italy.
Francesco
F
Ardito
Hepatobiliary Unit, Department of Surgical Sciences, A. Gemelli Medical School, Largo Gemelli, 800168, Rome, Italy.
Gennaro
G
Nuzzo
Hepatobiliary Unit, Department of Surgical Sciences, A. Gemelli Medical School, Largo Gemelli, 800168, Rome, Italy.
Felice
F
Giuliante
D000328:Adult; D000368:Aged; D001646:Bile / Q000382:microbiology*; D001653:Bile Ducts, Intrahepatic / Q000382:microbiology*; D002758:Cholangiography / Q000009:adverse effects; D002761:Cholangitis / Q000150:complications / Q000382:microbiology; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007239:Infections / Q000209:etiology* / Q000382:microbiology; D020347:Lithiasis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult