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Hepatic resection for hepatolithiasis and long-term results
K Chijiiwa1, N Kameoka, M Komura
1Department of Surgery 1, Kyushu University, Faculty of Medicine, Fukuoka, Japan.
Insights
Hepatic resection effectively treats hepatolithiasis (bile duct stones). While generally safe, additional biliary drainage procedures may increase mortality risk, though further study is needed.
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Surgical oncology
Background:
- Hepatolithiasis poses significant clinical challenges.
- Hepatic resection is a primary surgical intervention for hepatolithiasis.
- Long-term outcomes of hepatic resection require thorough evaluation.
Purpose of the Study:
- To appraise the long-term results of hepatic resection in patients with hepatolithiasis.
- To evaluate the efficacy of hepatic resection in achieving stone clearance.
- To assess the impact of associated procedures on patient outcomes.
Main Methods:
- Retrospective analysis of 127 patients with hepatolithiasis between 1973 and 1993.
- Focus on 43 patients who underwent hepatic resection.
- Inclusion of cholangioscopy in stone clearance assessment.
Main Results:
- Operative mortality was 2.3%.
- Complete stone clearance rates were 67% with surgery alone and 87% with added cholangioscopy.
- Stone recurrence occurred in 15% of patients.
- Mortality was higher in patients with associated biliary drainage procedures (p < 0.05).
Conclusions:
- Hepatic resection is an adequate treatment for hepatolithiasis.
- Associated biliary drainage procedures may be linked to higher mortality.
- Causality regarding drainage procedures cannot be concluded due to non-randomized patient selection.
Background:
Hepatic resection is an established procedure for treating patients with hepatolithiasis. The long-term results after hepatic resection for hepatolithiasis were appraised.
Study Design:
Of 127 patients with hepatolithiasis seen between 1973 and 1993, 43 patients underwent hepatic resection, and constituted the basis of this study.
Results:
There was one operative death (operative mortality rate of 2.3 percent) and three deaths as a result of concomitantly associated cholangiocellular carcinoma. Of the remaining 39 patients, the complete stone clearance rate was 67 percent with operation alone, but reached 87 percent when cholangioscopy was used. Operative morbidity was recorded in five patients (12 percent), but they recovered with conservative therapy. Stones recurred in 15 percent of patients after a mean follow-up period of four years (range of three to six years). Eleven (28 percent) of 39 patients died after hepatectomy as a result of related diseases after a mean follow-up of 6.2 years. These 11 patients had associated biliary drainage procedures. They experienced a higher mortality rate (p < 0.05) than patients who did not have biliary drainage.
Conclusions:
We conclude that hepatic resection is adequate treatment for hepatolithiasis. The patients having additional biliary drainage procedures had a higher mortality, but one cannot reach conclusions about the negative effect of the drainage procedures because the drainage procedures were done in a selected and not a randomized manner.