Role of hepatic resection in the treatment of hepatolithiasis

Background. The aim of the present study was to evaluate the safety and the efficacy of hepatic resection in the treatment of hepatolithiasis with intrahepatic biliary strictures. Methods. Experimental design: retrospective study. Setting: University hospital, Italy. Patients: 6 consecutive patients with single lobe hepatolithiasis operated on during the 4-year period 1994-98 inclusive. Interventions: major hepatic resections (3 left hepatectomies, 2 left Iobectomies, 1 right hepatectomy). Main outcome measures: type and duration of the surgical procedure, intra/postoperative blood losses, intra/postoperative course and complications, pathology, and hepatolithiasis recurrence. Results. Mean operative time was 3.34 +/- 0.02 hrs (range 3.0-4.3 hrs). Mean blood loss was 233 +/- 150 ml (range 100-500 ml). No patient required intra/postoperative blood transfusions. No intraoperative complication was recorded. Mean postoperative hospitalization was 17 +/- 7 days (range 6-28 days). Postoperative course was uneventful in 4 (66%) cases. No postoperative mortality was recorded. One pancreatitis and 1 biliary fistula occurred, for an overall postoperative morbidity of 33%. Pathology showed cholangiocarcinoma in 2 cases (33%). During the follow-up period (range 3-48 months, mean 19.1 +/- 16.4 months), 1 patient had recurrent cholangitis due to right lobe lithiasis and 1 patient died for cholangiocarcinoma. Conclusions. Hepatic resection is the treatment of choice in patients with single lobe hepatolithiasis and unreversible biliary strictures or possible presence of cholangiocarcinoma. An early indication for surgery may reduce the mortality/morbidity rates of hepatic resection for hepatolithiasis.