Hepatolithiasis; case series, review and current management strategy

Abstract

Background: Intrahepatic biliary tract stone formation is referred to as hepatolithiasis (HL). Hepatolithiasis causes local and systemic complications and insufficient treatment Methods with increased risk of reoccurrence makes it an important health problem. Surgical interventions ranges from endoscopic attempts to small segment resection and finally to liver transplant. Here in, we evaluated the patients who are diagnosed with HL and the treatment strategies in light of the current literature. Materials and Methods: Patients who are diagnosed with HL between the years of 2014 to 2018 and the applied treatment strategies were retrospectively examined. Patient demographics, causes of disease, complications and the treatment options of the patients were evaluated. Results: Totaly 16 patients were admitted to the study. Mean age of the patients was 64.3. We determined that 7 patients had been received cholecystectomy before. Out of these 7 patients, three patients, because they had been operated for main bile duct trauma during laparoscopic cholecystectomy, had been suffered from anastomotic stenosis in which has 2 hepaticojejunostomy (HJ) stenosis and 1 hepaticoduodenostomy stenosis with metal stent. Also, HJ stenosis and then HL developed in one patient after Whipple procedure. Ultrasonography, EUS, MRCP, CT, ERCP, PTC Methods are applied for diagnostic purposes. Eight patients were operated for HL; left hepatectomy for 2 patients and lateral sector resection in one patient. HJ revised in two patients. Stenotic region including stent ingrowth and fibrotic stricture resected and neo-hepaticojejunostomy performed in 2 patients. Anastomotic resection and portojejunostomy (Kasai) performed in one patient. All of HJ were done in Roux-en-Y style. The remaining 8 patients were observed with medical and endoscopic approaches. Discussion and Conclusions: Hepatolithiasis is a serious condition that requires multimodal treatment approaches. Anastomosis stenosis and stent implementation promote hepatolithiasis formation and increase recurrence. Functional HJ procedures will especially decrease the formation of this complication.