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Liver resection for intrahepatic stones
Moon-Tong Cheung1, Philip Chong-Hei Kwok
1Department of Surgery, Queen Elizabeth Hospital, Gascoigne Road, Kowloon, Hong Kong. qehsurg@ha.org.uk
Archives of Surgery (Chicago, Ill. : 1960)
|October 19, 2005
Summary
Liver resection offers excellent long-term outcomes for selected hepatolithiasis patients. Percutaneous stone removal is less effective, especially with complex cases like bilateral stones or strictures.
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Surgical outcomes
Background:
- Hepatolithiasis, or intrahepatic stones, poses significant treatment challenges.
- Treatment strategies aim to achieve stone clearance and prevent recurrence while minimizing morbidity.
Purpose of the Study:
- To evaluate the long-term outcomes of liver resection versus percutaneous choledochoscopy for hepatolithiasis.
- To identify risk factors associated with poor outcomes in hepatolithiasis management.
Main Methods:
- Retrospective study of 174 patients with hepatolithiasis.
- Comparison of liver resection (52 procedures) versus percutaneous choledochoscopy (149 procedures).
- Primary outcome measure was recurrence of cholangitis.
Main Results:
- Liver resection achieved a 98.0% success rate with a 13.3% chance of biliary sepsis at 5 years.
- Percutaneous choledochoscopy had a 70.5% success rate, with higher risks of biliary sepsis (26.4%-43.2%) in patients with strictures.
- Bilateral stones, strictures, and atrophy were significant risk factors for poor outcomes with stone removal alone.
Conclusions:
- Liver resection provides excellent long-term results for selected hepatolithiasis patients.
- Percutaneous stone removal is associated with poorer outcomes, particularly in complex cases.
- Liver resection indications should expand to include patients with strictures and bilateral stones.