Abstract
Background
Hepatolithiasis is a prevalent disease in Asia but rare in Western countries. An increasing
number of cases have been reported in Latin America. Liver resection has been proposed
as a definitive treatment for complete stone clearance. The aim of this study was
to evaluate the postoperative outcomes of liver resection for the treatment of hepatolithiasis
in 2 large hepatobiliary reference centers from South America.
Methods
We conducted a retrospective descriptive analysis from patients with hepatolithiasis
who underwent liver resection between November 1986 and December 2018, in 2 Latin-American
centers in Chile and Brazil.
Results
One hundred forty-nine patients underwent liver resection for hepatolithiasis (72
in Chile, 77 in Brazil). The mean age was 49 years and most patients were female (62.4%).
Hepatolithiasis was localized in the left lobe (61.7%), right lobe (24.2%), and bilateral
lobe (14.1%). Bilateral lithiasis was associated with higher incidence of preoperative
and postoperative cholangitis (81% vs 46.9% and 28.6% vs 6.1%) and need for hepaticojejunostomy
(52.4%). In total, 38.9% of patients underwent major hepatectomy and 14.1% were laparoscopic.
The postoperative stone clearance was 100%. The 30-day morbidity and mortality rates
were 30.9% and 0.7%, respectively. Cholangiocarcinoma was seen in 2 specimens, and
no postoperative malignancy were seen after a median follow-up of 38 months. Fourteen
patients (9.4%) had intrahepatic stones recurrence.
Conclusions
Liver resection is an effective and definitive treatment for patients with hepatolithiasis.
Bilateral hepatolithiasis was associated with perioperative cholangitis, the need
for hepaticojejunostomy, and recurrent disease. Resection presents a high rate of
biliary tree stone clearance and excellent long-term results, with low recurrence
rates and low risk of malignancy.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Twenty-two year experience with the diagnosis and treatment of intrahepatic calculi.Surg Gynecol Obstet. 1984; 159: 519-524
- Non-oriental primary intrahepatic lithiasis: experience with 48 cases.World J Surg. 2005; 29: 858-862
- Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features.Semin Liver Disease. 2011; 31: 33-48
- Natural progression of untreated hepatolithiasis that shows no clinical signs at its initial presentation.J Clin Gastroenterol. 2001; 33: 114-117
- Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis.Surg Endosc. 2005; 19: 505-509
- Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis.Am J Gastroenterol. 2003; 98: 2655-2662
- Management of hepatolithiasis: review of the literature.Curr Gastroenterol Rep. 2020; 22: 1-9
- Hepatic resection for primary hepatolithiasis: a single-center Western experience.J Am Coll Surg. 2012; 215: 622-626
- Surgical management of hepatolithiasis: a minireview.Intract Rare Dis Res. 2017; 6: 102
- Surgical resection for non-Asian intrahepatic lithiasis: The Brazilian experience.Asian J Surg. 2021; 44: 553-559
- Anatomic hepatectomy as a definitive treatment for hepatolithiasis: a cohort study.HPB. 2012; 14: 604
- Liver resection as the definitive treatment for unilateral non-oriental primary intrahepatic lithiasis.Am J Surg. 2006; 191: 460-464
- Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?.World J Gastroenterol. 2010; 16: 3423
- Immediate and long-term outcomes of hepatectomy for hepatolithiasis.Surgery. 2004; 135: 386-393
- Outcomes of liver resection for intrahepatic stones: a comparative study of unilateral versus bilateral disease.Ann Surg. 2012; 255: 946-953
- Outcomes of hepatic resection for hepatolithiasis.Am J Surgery. 2009; 198: 199-202
- Laparoscopic VS open hepatectomy for hepatolithiasis: an updated systematic review and meta-analysis.World J Gastroenterol. 2017; 23: 7791
- Application of laparoscopic technique in the treatment of hepatolithiasis.Surg Laparosc Endosc Percutan Tech. 2021; 31: 247-253
- Right hepatolithiasis and abnormal hepatic duct confluence: more than a casual relation?.Am J Surg. 2011; 201: 514-518
- Outcomes of hepatectomy for hepatolithiasis.World J Surg. 2007; 31: 479-482
- Comparison between percutaneous transhepatic rigid cholangioscopic lithotripsy and conventional percutaneous transhepatic cholangioscopic surgery for hepatolithiasis treatment.Surg Laparosc Endosc Percutan Tech. 2016; 26: 54-59
- Percutaneous transhepatic placement of metallic stents in the treatment of complicated intrahepatic biliary stricture with hepatolithiasis: a preliminary report.Am J Gastroenterol. 1999; 94: 3507-3512
- Percutaneous transhepatic cholangioscopic treatment for hepatolithiasis: an evaluation of long-term results and risk factors for recurrence.Gastrointest Endosc. 2001; 53: 318-323
- Liver resection for intrahepatic stones.Archiv Surg. 2005; 140: 993-997
- Hepatolithiasis and intrahepatic cholangiocarcinoma: a review.World J Gastroenterol. 2015; 21: 13418-13431
- Clinical experience of intrahepatic cholangiocarcinoma associated with hepatolithiasis.Japan J Surg. 1988; 18: 47-53
- Liver Resection for primary intrahepatic stones: a single-center experience.Archiv Surg. 2008; 143: 570-573
- Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures.Ann Surg. 2003; 238: 93
- Reappraisal of the systematic management of complicated hepatolithiasis with bilateral intrahepatic biliary strictures.Archiv Surg. 1996; 131: 141-147
Article info
Publication history
Published online: November 29, 2022
Accepted:
October 22,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
