[Intrahepatic lithiasis]

From 1982 to 1993 9 patients with primary intrahepatic lithiasis and 49 with secondary intrahepatic lithiasis were treated. Out of the first group of patients, 2 underwent right hepatectomy, 2 left hepatectomy and 1 lithotomy + hepatico-jejunostomy. No death occurred within thirty days from operation: morbidity occurred as a consequence of wound infection in one case and bronchopulmonary complications in two cases. At follow-up (6 months-11 years) 1 cholangitis and 1 relapse were found. Secondary intrahepatic lithiasis was treated as follows: in 15 cases we performed lithotomy + cholangio-jejunostomy + 9 postoperative percutaneous transhepatic cholangio-jejunostomy + 9 postoperative percutaneous transhepatic cholangioscopies (PTCS) + 2 cutaneous jejunostomies; in 5 cases lithotomy + papillosphincteroplasty (PSP) + Kehr + 1 trans-Kehr fiber cholangioscopy (PTKCS); in 1 case lithotomy + choledochoduodenostomy (CDS); in 3 cases right hepatectomy and in 4 cases left hepatectomy; in 14 cases lithotomy + hepatico-jejunostomy; in 5 cases PTKCS alone and in 2 cases PTCS alone. Overall mortality summed up to one case only. Overall morbidity occurred in the shape of two biliary fistulas, 3 subhepatic abscesses, 8 bronchopulmonary complications, 4 wound infections, 1 ileal perforation. Follow-up (6 months-11 years) revealed 2 stenosis of the biliodigestive anastomosis, 3 cholangitis relapses and 2 relapsing lithiasis. Since 18 cases were successfully treated through postoperative fiber cholangioscopy, the authors come to the conclusion that in all cases not requiring hepatectomy due to monolateral lithiasis, it is always advisable to leave open an access to the biliary tract, which might allow further improving maneuvers after surgery.