title: Selection of surgical treatment types for intrahepatic duct stones.
abstract: OBJECTIVE
  Complete elimination of intrahepatic duct (IHD) stones is difficult and IHD stone disease is frequently associated with various complications, recurrence and sometimes cholangiocarcinoma. Therefore, we analyzed the long-term surgical results and evaluated the management currently considered appropriate.
  
  
  METHODS
  Overall 110 patients who had been diagnosed with benign IHD stone disease and who underwent surgical treatment were enrolled in this study. The patients were categorized into three groups according to the type of surgery performed; liver resection (LR) group, intrahepatic duct exploration (IHDE) group and hepaticoenterostomy (HE) group. We compared and analyzed the results of these three groups.
  
  
  RESULTS
  The number of cases in the LR group, IHDE group and HE group were 77, 25 and 8 respectively. The LR group required a longer operation time (p=0.000), more frequent transfusion (p=0.028) and had higher morbidity (p=0.049). However, the LR group had a higher clearance rate (90.9%) (p=0.000) than the other groups. In addition, there were a total of 22 cases of IHD stone recurrence during the follow-up, but there was no statistically significant difference among the three groups. The location of IHD stones was related to a risk factor for incomplete stone removal, but not for recurrence.
  
  
  CONCLUSIONS
  The fundamental principle for the treatment of IHD stone disease should be liver resection. However, it can lead to a longer operative time and higher rate of complications than the other procedures. There is also no difference in the IHD stone recurrence rate among the procedures. Therefore, these alternative and minor procedures could also be taken into account for patients with poor preoperative condition.
authors.affiliation: Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Kyung Sook
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Kyoung Tae
authors.initials: KT
authors.lastname: Noh
authors.affiliation: Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Seog Ki
authors.initials: SK
authors.lastname: Min
authors.affiliation: Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Hyeon Kook
authors.initials: HK
authors.lastname: Lee
keywords: Hepaticoenterostomy; Intrahepatic duct exploration; Intrahepatic duct stones; Liver resection