Management of Complicated Recurrent or Residual Hepatolithiasis

Abstract

As the patterns of gallstone disease have changed, those with recurrent or residual hepatolithiasis (the so-called complicated hepatoliththiasis) are becoming more and more problematic. How to treat them properly is a new challenge. Contrast cholangiography as well as computed tomography or magnetic resonance cholangiography is necessary to delineate the location of stones, duct strictures, and possible coexisting malignancy preceding surgical or other biliary interventions. Resection of the involved segment or lobe of the liver is a safe and effective treatment for localized hepatolithiasis. Cholangioscopic lithotomy, either intraoperative, postoperative, or a percutaneous minimally invasive procedure without reoperation is important in stone eradication. Chemical biliary duct embolization to prevent stone recurrence has recently been reported. The antagonist of the epidermal growth factor receptor might suppress proliferative cholangitis in animal studies. To obtain a good long term outcome, it is important to keep in mind the possibility of coexisting intrahepatic cholangiocarcinoma, either before, during, or after treatment of complex hepatolithiasis. For complicated hepatolithiasis, a systematic approach with multimodal treatment by a cooperative team is recommended.