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Hepatolithiasis: clinical series, review and current management strategy
Osman Nuri Dilek1, Ahmet Atasever1, Nihan Acar1
1Department of Surgery, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey.
Insights
Hepatolithiasis (HL) is a complex liver stone condition requiring a multimodal treatment approach. Functional hepaticojejunostomy may help reduce recurrence and complications associated with HL.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Surgical Oncology
Background:
- Hepatolithiasis (HL) presents significant challenges due to local/systemic complications and high recurrence rates.
- Treatment options for HL range from endoscopic procedures to major resections and liver transplantation.
- Evaluating treatment strategies for HL is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate treatment strategies for hepatolithiasis (HL) in patients diagnosed between 2014-2019.
- To analyze demographic characteristics, causes, complications, and treatment outcomes for HL patients.
- To identify factors influencing HL recurrence and inform optimal management approaches.
Main Methods:
- Retrospective analysis of 17 patients diagnosed with hepatolithiasis (HL) from 2014-2019.
- Evaluation of patient files for demographic data, disease etiology, complications, and treatment interventions.
- Review of surgical (e.g., hepatectomy, hepaticojejunostomy revision) and non-operative management strategies.
Main Results:
- 17 patients (mean age 64.3 years) with HL were studied; 7 had prior cholecystectomies.
- Complications included anastomotic stenosis in hepaticojejunostomy (HJ) and hepaticoduodenostomy sites.
- Surgical interventions included hepatectomy, HJ revision, and neo-hepaticojejunostomy; 8 patients were managed non-operatively.
Conclusions:
- Hepatolithiasis (HL) necessitates a multimodal treatment strategy.
- Anastomotic stenosis and stenting are identified as facilitators of HL development and recurrence.
- Implementing functional hepaticojejunostomy is recommended to decrease HL recurrence.
Objectives:
Hepatolithiasis (HL) continues to be a problem due to its local and systemic complications, insufficiency in treatment modalities and high risk of recurrence. There are various surgical options available, ranging from endoscopic interventions to a small segment resection and ultimately to transplantation. In this article, patients with the diagnosis of HL and our treatment strategies were evaluated in the light of literature.
Material And Methods:
The patients diagnosed with HL in our clinic between 2014-2019 were evaluated retrospectively by examining the patient files. Demographic characteristics of the patients, causes of the disease, complications and treatment options were evaluated.
Results:
17 patients were included into the study. Mean age of the patients was 64.3 years (range 32-89 years). Seven patients had previous cholecystectomies. Stenosis was found to be developed in hepaticojejunostomy (HJ) site in three patients (two had HJ due to bile duct injury and one had HJ following the Whipple procedure), and in hepaticoduodenostomy site in one patient who had the history of biliary tract injury during cholecystectomy. Two patients with HL without previous cholecystectomies had no gallbladder stones. Nine patients underwent surgery. Left hepatectomy was performed in two patients and lateral sector resection was performed in 2 patients. Two patients with anastomotic stenosis underwent HJ revision and two patients with anastomotic stenosis and one patient with stent ingrowth underwent bifurcation resection and neo-hepaticojejunostomy. Eight patients were followed-up nonoperatively with medical and endoscopic approaches.
Conclusion:
Hepatolithiasis is a serious condition that needs to be treated with a multimodal approach. Stenting and anastomotic stenosis facilitate the development of hepatolithiasis and increase the risk of its occurrence. In particular, by performing functional hepaticojejunostomy, the development of this complication will be decreased.
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