[Treatment of hepatolithiasis--current problems in view of analysis of stones]

We analyzed 24 intrahepatic gallstones for their components by chemical assay and evaluation of atomic absorbance. Those with high cholesterol and fatty acid contents were noted in addition to conventional bilirubin-calcium gallstones, and a mean cholesterol content of over 50% was observed in one fourth of the hepatic gallstones. Measurement of biliary bilirubin and calcium levels conducted to investigate the causative factors of bilirubin gallstones showed that they occur more readily in bile containing less bilirubin, suggesting that their development is largely dependent on the amount of bile acids in hepatic bile determined by the biliary acidity, presence of unconjugated bilirubin, and ionization of calcium. Our results suggest the necessity of treating hepatolithiasis as a hepatic disease with constitutional implications and, in the absence of clear insight into its etiology, of selecting surgical modes always with proper consideration to the possibility of recurrence. Therefore, choledochojejunostomy combined with jejunostomy is our primary surgical procedure.