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Updated: Oct 5, 2026
Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
Published on: March 10, 2023
Role of hepatic resection in the treatment of hepatolithiasis
L Aldrighetti1, M Arru, R Caterini
1Department of Surgery, Scientific Institute H San Raffaele, Milan, Italy. aldrighetti.luca@hsr.it
Insights
Hepatic resection effectively treats hepatolithiasis with biliary strictures, showing low morbidity and no mortality in this study. Early surgery for hepatolithiasis may improve outcomes.
Area of Science:
- Hepatobiliary Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Hepatolithiasis, or stones in the bile ducts, often presents with intrahepatic biliary strictures.
- Surgical management of hepatolithiasis with strictures requires careful consideration of safety and efficacy.
Purpose of the Study:
- To evaluate the safety and efficacy of hepatic resection for hepatolithiasis complicated by intrahepatic biliary strictures.
- To assess outcomes including complications, morbidity, and recurrence rates following hepatic resection.
Main Methods:
- Retrospective study of 6 consecutive patients undergoing major hepatic resections for single-lobe hepatolithiasis.
- Procedures included left hepatectomies, left lobectomies, and right hepatectomy between 1994 and 1998.
- Outcomes assessed: operative time, blood loss, complications, pathology, and recurrence.
Main Results:
- Mean operative time was 3.34 hours with minimal blood loss (mean 233 ml), no transfusions required.
- Postoperative hospitalization averaged 17 days, with 33% morbidity (pancreatitis, biliary fistula); no operative mortality.
- Cholangiocarcinoma was found in 33% of cases; follow-up revealed recurrent cholangitis in one and cholangiocarcinoma death in another.
Conclusions:
- Hepatic resection is a primary treatment for single-lobe hepatolithiasis with unresectable strictures or suspected cholangiocarcinoma.
- Early surgical intervention for hepatolithiasis can potentially decrease associated mortality and morbidity rates.
Background:
The aim of the present study was to evaluate the safety and the efficacy of hepatic resection in the treatment of hepatolithiasis with intrahepatic biliary strictures.
Experimental Design:
retrospective study.
Setting:
University hospital, Italy.
Patients:
6 consecutive patients with single lobe hepatolithiasis operated on during the 4-year period 1994-98 inclusive.
Interventions:
major hepatic resections (3 left hepatectomies, 2 left lobectomies, 1 right hepatectomy).
Main Outcome Measures:
type and duration of the surgical procedure, intra/postoperative blood losses, intra/postoperative course and complications, pathology, and hepatolithiasis recurrence.
Results:
Mean operative time was 3.34+/-0.02 hrs (range 3.0-4.3 hrs). Mean blood loss was 233+/-150 ml (range 100-500 ml). No patient required intra/postoperative blood transfusions. No intraoperative complication was recorded. Mean postoperative hospitalization was 17+/-7 days (range 6-28 days). Postoperative course was uneventful in 4 (66%) cases. No postoperative mortality was recorded. One pancreatitis and 1 biliary fistula occurred, for an overall postoperative morbidity of 33%. Pathology showed cholangiocarcinoma in 2 cases (33%). During the follow-up period (range 3-48 months, mean 19.1+/-16.4 months), 1 patient had recurrent cholangitis due to right lobe lithiasis and 1 patient died for cholangiocarcinoma.
Conclusions:
Hepatic resection is the treatment of choice in patients with single lobe hepatolithiasis and unreversible biliary strictures or possible presence of cholangiocarcinoma. An early indication for surgery may reduce the mortality/morbidity rates of hepatic resection for hepatolithiasis.