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Caudate lobe-sparing subtotal hepatectomy for primary hepatolithiasis
1Hospital and Institute of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Chinese PLA Postgraduate Medical School, Beijing, China. dongjh301@163.com
Insights
Caudate lobe-sparing subtotal hepatectomy effectively treated patients with severe hepatolithiasis and cholangitis. This procedure offered a safe and successful alternative for managing complex liver conditions, leading to symptom relief in most cases.
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Surgical oncology
Background:
- Bilateral primary hepatolithiasis can cause frequent, life-threatening cholangitis.
- Atrophy of the main liver with caudate lobe hypertrophy presents unique surgical challenges.
Purpose of the Study:
- To assess the safety and efficacy of caudate lobe-sparing subtotal hepatectomy.
- To evaluate outcomes in patients with complex hepatolithiasis and cholangitis.
Main Methods:
- Retrospective analysis of prospectively collected data (March 2003-December 2009).
- Subtotal hepatectomy involving resection of 7 liver segments, preserving the caudate lobe.
- Concomitant bile duct exploration and choledochoscopy were performed.
Main Results:
- Immediate stone clearance achieved in all 12 patients.
- No hospital mortality; 3 patients experienced 6 complications.
- At a mean 51-month follow-up, 11 of 12 patients remained symptom-free from cholangitis.
Conclusions:
- Caudate lobe-sparing subtotal hepatectomy is a safe and effective treatment for selected patients.
- This approach offers a viable solution for complex bilateral primary hepatolithiasis.
Background:
Patients with frequent and life-threatening attacks of cholangitis due to bilateral primary hepatolithiasis with atrophy of the main liver and giant hypertrophy of the caudate lobe were assessed for caudate lobe-sparing subtotal hepatectomy.
Methods:
This was a retrospective study of prospectively collected data from patients who underwent subtotal hepatectomy with sparing of the caudate lobe (resection of 7 liver segments, leaving only the caudate lobe) between March 2003 and December 2009. All patients had concomitant bile duct exploration and choledochoscopy. Perioperative and long-term outcomes were analysed.
Results:
Immediate stone clearance was obtained in all 12 patients enrolled in the study. Two patients had strictureplasty of the strictured caudate bile duct. There was no hospital mortality and six complications developed in three patients. At a mean follow-up of 51 months, one patient had developed recurrent stones in the caudate lobe bile ducts at 8 months and died from acute purulent cholangitis, 17 months after surgery. The remaining 11 patients were symptom-free with no further attacks of acute cholangitis.
Conclusion:
In selected patients with bilateral primary hepatolithiasis, caudate lobe-sparing subtotal hepatectomy is a safe and effective treatment.
