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Hepatectomy for bilateral primary hepatolithiasis: a cohort study.
Tian Yang1, Wan Yee Lau, Eric C H Lai
1Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Annals of Surgery
|December 25, 2009
Summary
Partial hepatectomy with choledochoscopic lithotripsy offers a safe and effective treatment for complicated bilateral primary hepatolithiasis. This approach achieves high stone clearance and good long-term survival in selected patients.
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Surgical oncology
Background:
- Hepatolithiasis management requires a multidisciplinary approach.
- Treatment options include endoscopic, percutaneous, laparoscopic, or open surgery.
- Partial hepatectomy is reserved for severe, recurrent, or localized hepatolithiasis.
Purpose of the Study:
- To evaluate the perioperative and long-term outcomes of partial hepatectomy for complicated bilateral primary hepatolithiasis.
- To assess the efficacy and safety of this surgical approach.
Main Methods:
- A retrospective analysis of 136 patients undergoing bilateral or unilateral hepatectomy for hepatolithiasis and biliary strictures (2000-2006).
- All patients had concomitant bile duct exploration.
- Perioperative and long-term outcomes were analyzed.
Main Results:
- Immediate stone clearance rates were 81.5% (bilateral) and 65.9% (unilateral), increasing to 85.2% and 81.7% post-lithotripsy.
- Hospital mortality rates were 5.6% (bilateral) and 0% (unilateral).
- 5-year overall survival rates were 98% (bilateral) and 91.5% (unilateral).
Conclusions:
- Partial hepatectomy combined with choledochoscopic lithotripsy is safe and effective for selected patients with biliary strictures and bilateral hepatolithiasis.
- This treatment offers high immediate stone clearance and favorable long-term survival.
- Low long-term stone recurrence rates were observed.