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[Intrahepatic calculosis].

G Nuzzo1, G Clemente, F Giuliante

  • 1Cattedra di Chirurgia Geriatrica, Università Cattolica del S. Cuore, Roma.

Annali Italiani Di Chirurgia
|April 24, 1999
PubMed
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This review of intra-hepatic lithiasis shows improved outcomes over three decades. Advances in diagnosis and non-surgical treatments like ERCP and PTC significantly reduced mortality and increased stone clearance rates.

Area of Science:

  • Hepatobiliary Surgery
  • Gastroenterology
  • Interventional Radiology

Context:

  • Intra-hepatic lithiasis (gallstones within the liver's bile ducts) presents complex diagnostic and therapeutic challenges.
  • A 30-year review (1967-1996) of 100 cases by a single surgical team provides insights into evolving management strategies.

Purpose:

  • To analyze the changing diagnostic modalities and treatment approaches for intra-hepatic gallstones.
  • To evaluate the impact of these changes on clinical outcomes, including mortality and stone clearance rates.

Summary:

  • The study reviewed 100 cases of intra-hepatic lithiasis, categorizing stones as migrated or primary duct stones.
  • Surgical interventions evolved from open CBD stone removal to bilio-enteric anastomosis and liver resection for complex cases.

Related Experiment Videos

  • Non-surgical options, including endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), gained prominence after 1980, sometimes combined with extracorporeal lithotripsy.
  • Diagnosis progressed from intraoperative methods to advanced imaging like ultrasonography and CT, improving detection and guiding treatment.

    • Impact:

    • Mortality rates decreased progressively from 8.3% (1967-1976) to 0% in the last decade (1987-1996).
    • Complete stone clearance rates improved significantly, rising from 70.8% to 97% over the study period.
    • The development and adoption of minimally invasive endoscopic and percutaneous techniques revolutionized the management of intra-hepatic gallstones, enhancing patient outcomes.