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[Hepatectomy in intrahepatic lithiasis].

K S Do1, G K Tran, T T Doan

  • 1Service de chirurgie hépatobiliaire, Hôpital Viet Duc, Hanoi, Vietnam.

Chirurgie; Memoires De L'Academie De Chirurgie
|February 17, 2000
PubMed
Summary

Hepatic resection effectively treats hepatolithiasis (bile duct stones) in Vietnam, a high-incidence region. This surgical approach offers positive outcomes for localized intrahepatic stones, even in emergency cases.

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Area of Science:

  • Hepatobiliary surgery
  • Gastroenterology
  • Surgical oncology

Background:

  • Hepatolithiasis, or intrahepatic bile duct stones, presents a significant clinical challenge, particularly in regions like Vietnam.
  • Previous operations for hepatolithiasis were common in the study cohort, indicating recurrent disease or incomplete initial treatment.

Purpose of the Study:

  • To evaluate the immediate surgical outcomes of hepatic resections for hepatolithiasis.
  • To assess the feasibility and safety of the Ton That Tung technique for these procedures.

Main Methods:

  • A series of 65 hepatic resections for hepatolithiasis were performed between 1986 and 1998.
  • Procedures included minor resections (55 left lobectomies) and major resections, utilizing a transhepatic approach with external biliary drainage (Kehr tube).

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  • Indications included angiocholitis, liver abscess, impacted stones, hemobilia, and biliary strictures.

    • Main Results:

    • The study reported a 9% postoperative mortality rate (6 deaths), with causes including septic shock, cachexia, and liver failure.
    • Complications occurred in 15 patients but were successfully managed with conservative therapy.
    • Bile cultures revealed high infection rates (93%), predominantly by Escherichia coli and Enterobacter, with pigmented stones being common.

    Conclusions:

    • Hepatic resection is a suitable treatment for localized intrahepatic bile duct stones, especially when biliary strictures and calculi can be fully excised.
    • The procedure can be safely performed on an emergency basis for conditions like liver abscess or hemobilia.
    • Vietnam exhibits a high prevalence of hepatolithiasis, underscoring the importance of effective surgical management strategies.