Intrahepatic bile duct exploration lithotomy is a useful adjunctive hepatectomy method for bilateral primary hepatolithiasis: an eight-year experience at a single centre

En-Liang Li,Wen-Jun Liao,Jun Lei,Lin-Quan Wu,Rong-Fa Yuan,Qian Feng,Xiang-Bao Yin,Jiang-Hua Shao

doi:10.1186/s12893-019-0480-1

Abstract

BackgroundTo evaluate the perioperative and long-term results of intrahepatic bile duct exploration lithotomy (IHBDIL) combined with hepatectomy for patients with complicated bilateral primary hepatolithiasis.MethodsA study was conducted involving 56 patients with complicated bilateral primary hepatolithiasis who underwent IHBDIL combined with hepatectomy at our hospital from January 2006 to December 2014. The perioperative and long-term outcomes that were retrospectively analysed included the stone clearance rate, operative morbidity and mortality, and stone recurrence rate. Patients with a preoperative diagnosis of cholangiocarcinoma were excluded.ResultsIn all 56 patients, hepatic duct stones were located in the bilateral IHBD. The surgical method was IHBDIL combined with hepatectomy. Postoperative complications occurred in 15 patients (26.8%), 14 patients responded to conservative management, and there was 1 case of postoperative mortality because of hepatic failure. The overall initial success rate of stone clearance was 85.7%, and the final clearance rate was 92.9% following postoperative choledochoscopic lithotripsy. The stone recurrence rate was 13.5%, and the occurrence of postoperative cholangitis was 10.9% during the follow-up period.ConclusionIHBDIL combined with hepatectomy is a safe, effective, and promising treatment for patients with complicated bilateral primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for complicated bilateral primary hepatolithiasis.

Highlights

To evaluate the perioperative and long-term results of intrahepatic bile duct exploration lithotomy (IHBDIL) combined with hepatectomy for patients with complicated bilateral primary hepatolithiasis
The study included 56 patients with stones mainly located in the bilateral Intrahepatic bile duct (IHBD); these patients underwent Intrahepatic bile duct exploration lithotomy (IHBDIL) combined with hepatectomy
To the best of our knowledge, our series is the only series to evaluate the efficacy of IHBDIL combined with hepatectomy for bilateral primary hepatolithiasis

Summary

Introduction

To evaluate the perioperative and long-term results of intrahepatic bile duct exploration lithotomy (IHBDIL) combined with hepatectomy for patients with complicated bilateral primary hepatolithiasis. Complicated hepatolithiasis could be extended to include complications of intrahepatic strictures and bilateral stones [2]. Because patients with complicated bilateral hepatolithiasis have perihepatic extensive adhesions from previous operations, recurrent biliary tract infections, liver abscesses and other complications, hepatectomy can become difficult, and there is a higher residual stone rate. Complicated bilateral hepatolithiasis can affect multiple hepatic segments and lead to hepatic parenchymal atrophy. IHBD stone requires resection of multiple liver segments; patients with complicated bilateral hepatolithiasis often cannot tolerate resection of multiple liver segments, which could lead to postoperative hepatic failure. The treatment of complicated bilateral hepatolithiasis remains a challenge

Methods

Results

Discussion

Conclusion