Caudate lobe-sparing subtotal hepatectomy for primary hepatolithiasis

Abstract

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. 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. 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. In selected patients with bilateral primary hepatolithiasis, caudate lobe-sparing subtotal hepatectomy is a safe and effective treatment.