Surgical therapy for hepatolithiasis

Abstract

Background: Hepatolithiasis [1] is very common in East Asia but infrequent in Western countries.[2] Is defined as the presence of multiple stones inside the bile ducts proximally to the biliary carrefour. Intrahepatic lithiasis could be classified in 2 types: Ectasia of Intrahepatic biliary duct withuot fibrosis (Caroli's Disease) and Obstructive dilatation of the intrahepatic bile duct secondary to ischemic stricture. Caroli's Disease (CD) is a rare congenital condition [3]. Malignancy is a complication of long – term CD, and some patients are presenting with [4] cholangiocarcinoma Methods: Between 1998 – 2016, 9 patients were operated on, 7 female and 2 male with a median age of 49,2 y.o (31 – 69). Most frequent symptoms were pain (5/55,5%), Abnormal LFT (3/33%) and Dyspepsia (1/11,1%). Hepatic distribution was: 5 patients in segments II, III and IV, and 4 in segment II and III. Open surgery was perfomed in 7 patients, and laparoscopic approach was carried out in 2. Results: Operative mortality was zero and morbidity rate was 1/11,1% (reoperated on due to bile leak and biliary peritonitis). Pathologycal examination showed CD in all cases; one of them had antral methaplasia. The mean follow-up period was 116,2 months (2-221). None presented recurrence of the symptoms. Conclusion: Surgical therapy is a safe and effective management for hepatolithiasis. The possibility of developing cholangiocarcinoma in inveterate patients is real, and hepatic resection removes the risk.