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Outcomes of hepatectomy for hepatolithiasis
Tung-Yen Lee1, Yao-Li Chen, Hung-Chi Chang
1Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Insights
Hepatectomy effectively treats hepatolithiasis, achieving high stone clearance rates. However, recurrent stones and cholangiocarcinoma pose risks to long-term survival.
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Surgical oncology
Background:
- Hepatolithiasis management involves surgical and nonsurgical options.
- Hepatectomy is a significant surgical approach for complex bile duct stones.
Purpose of the Study:
- To evaluate the immediate and long-term outcomes of hepatectomy for hepatolithiasis.
- To assess the efficacy and safety of hepatectomy in managing bile duct stones.
Main Methods:
- Retrospective analysis of 123 patients undergoing hepatectomy for hepatolithiasis (2000-2005).
- Focus on presenting symptoms, stone clearance, surgical complications, and long-term follow-up.
- Acute cholangitis was the primary presenting symptom in 86.2% of cases.
Main Results:
- Immediate stone clearance rate was 92.7%, with a final rate of 96% after additional procedures.
- Surgical morbidity was 33.3% and mortality was 1.6%.
- Long-term follow-up revealed recurrent stones in 5.7% and cholangiocarcinoma in 1.6% of patients. Recurrent stone-induced sepsis caused 3.2% of deaths.
Conclusions:
- Hepatectomy is a safe and effective treatment for hepatolithiasis, offering high stone clearance.
- Surgical complications are manageable, but recurrent stones and cholangiocarcinoma are critical for long-term survival.
- Close monitoring for recurrence and associated malignancies is essential post-hepatectomy.
Aim:
Surgical and nonsurgical procedures for management of hepatolithiasis have been reported. The aim of this study was to evaluate immediate and long-term results of hepatectomy as treatment for hepatolithiasis.
Materials And Methods:
Immediate and long-term outcomes of 123 consecutive patients who underwent hepatectomy for hepatolithiasis at our institution from 2000 to 2005 were analyzed retrospectively. Acute cholangitis was the major presenting symptom (in 106 out of 123, 86.2% of cases).
Results:
The immediate stone clearance rate was 92.7% (114 out of 123) and final stone clearance rate was 96% (118 out of 123) after subsequent T-tube route or endoscopic retrograde cholangiopancreatography (ERCP). Residual stones were identified in 5 patients (4%). The surgical morbidity and mortality rates were 33.3% (41 out of 123) and 1.6% (2 out of 123) respectively. Of the 123 patients, 3 (2.4%) had associated cholangiocarcinoma at the time of hepatectomy. With a median follow-up of 40.3 months (range 5-58), a recurrent stone developed in 7 patients (5.7%) and cholangiocarcinoma in 2 (1.6%). Ten patients died during the follow-up period, with 4 of them (out of 123, 3.2%) due to recurrent stone with sepsis.
Conclusion:
Hepatectomy is a safe and effective treatment for hepatolithiasis, with a high stone clearance rate and fair rate of surgical complications. Recurrent stone-induced sepsis and cholangiocarcinoma are the major factors compromising long-term survival in these patients.