Evaluation of Interdisciplinary Management of 53 Patients with Hepatolithiasis

Abstract

Purpose: The aim of this study was to report our experience of hepatolithiasis, diagnosed in 53 patients between January 2000 and December 2007. Methods: Fifty-three patients with hepatolithiasis in a period of 8 years were evaluated at the Hospital Pablo Tobón Uribe in Medellin-Colombia. Diagnosis of hepatolithiasis was based on cholangiography, ultrasonography and computed tomography. Patients with hepatolithiasis were classified according to Tsunoda classification. Results: 23 men (43%) and 30 women were studied, mean age 50±15 years (range 25-83 years). The pain predominated (94%), followed of jaundice (68%) and fever (57%). More frequently abdominal echography (85%) was done, followed by magnetic cholangioresonance (58%) and abdominal tomography (32%). According to the classification of Tsunoda, 6 patients were Tsunoda I, 12 Tsunoda II, 4 Tsunoda III and 5 Tsunoda IV. The most frequent commitment was of left lobe (36%) or bilateral (34%) Endoscopic cholangiography was successful in 64% and only 4 patients were treated by percutaneous cholangiography (2 successes). 35 patients were operated (66%) and most frequent surgery was the left hepatectomy in 40% (7 with subcutaneous loop) followed by hepatojejunostomy with subcutaneous loop (26%). Four orthotopic liver transplantations with good evolution were realized in patients with cirrhotic complications. The early complications were of 40%, the most frequent was infection of the operative site (14%) and residual stones (9%). The more frequent delayed complication was the residual stones (23%). 80% of the operated patients were asymptomatic compared with 72% of not operated. There was not operative mortality. Multivariate analysis showed that previous surgery was related to a worse clinical outcome (more symptomatic). Conclusion: Hepatolithiasis is a disease without a well standardized treatment and surgery is an alternative with good results, clinical improvement and little morbidity and mortality with the interdisciplinary support given by radiology and by biliary endoscopy.