Treatment outcome of hepatolithiasis: Nepalese experience
Keywords:Gallstones, Hepatolithiasis, Hepatectomy, Surgery
Background: Hepatolithiasis is a rare disease with high rate of treatment failure and recurrence. This study aims to review the burden, management and outcome from an endemic region.
Methods: A retrospective review of database of patients with hepatolithiasis managed surgically from 2015 to 2019 was performed. Diagnosis was based on the clinical findings and radiological investigations. Demographic data, clinical presentation, extent of disease and type of surgical management were evaluated. The outcome measures included immediate stone clearance, postoperative complications and follow-up.
Results: Hepatolithiasis was seen in nine (0.34%) out of 2,600 patients being evaluated for gallstone disease. Three patients were young, while the remaining six were in the middle-age group. The presenting symptoms were pain abdomen (78%) and jaundice (22%). Hepatolithiasis was located in the left, right and both ductal systems in 5, 1 and 3 patients respectively. Liver resection for unilateral disease was done in 3 patients: left hepatectomy (n=2) and left lateral segmentectomy (n=1). High bile duct exploration and bilio-enteric drainage was done in 5 patients. One patient required hepatolithotomy and T-tube drainage due to cholangitis. Complete stone clearance was achieved in 78%. Complications included surgical site infection and cholangitis in 2 patients. There was no operative mortality. Histopathology revealed recurrent pyogenic cholangitis. At median follow-up of 28 months, 7 patients are symptom-free.
Conclusions: Hepatectomy is an effective treatment when disease is confined to the left lobe. Combined surgical procedure is an acceptable option for bilateral or right-sided hepatolithiasis.
Sakpal SV, Babel N, Chamberlain RS. Surgical management of hepatolithiasis. HPB. 2009;11(3):194-202.
Ray S, Sanyal S, Das K, Ghosh R, Das S, Khamrui S, et al. Outcome of surgery for recurrent pyogenic cholangitis: a single center experience. HPB. 2016;18(10):821-6.
Cheon YK, Cho YD, Moon JH, Lee JS, Shim CS. Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis. Surgery. 2009;146(5):843-53.
Uenishi T, Hamba H, Takemura S, Oba K, Ogawa M, Yamamoto T, et al. Outcomes of hepatic resection for hepatolithiasis. Am J Surg. 2009;198(2):199-202.
Tazuma S. Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol. 2006;20(6):1075-83.
Kim HJ, Kim JS, Joo MK, Lee BJ, Kim JH, Yeon JE. Hepatolithiasis and intrahepatic cholangiocarcinoma: a review. World J Gastroenterol. 2015;21(48):13418-31.
Feng X, Zheng S, Xia F, Ma K, Wang S, Bie P, et al. Classification and management of hepatolithiasis: a high-volume, single-center’s experience. Intractable Rare Dis Res. 2012;1(4):151-6.
Uchiyama K, Onishi H, Tani M, Kinoshita H, Ueno M, Yamaue H, et al. Indication and procedure for treatment of hepatolithiasis. Arch Surg. 2002;137(2):149-53.
Villalabeitia BT, Serrano MC, Melero A, González MI, Carballo SR, Herrero SG. Hepatolithiasis as a cause of recurrent cholangitis. Surg Infect Case Rep. 2017;2(1):113-5.
Cha SW. Management of intrahepatic duct stone. Korean J Gastroenterol. 2018;71(5):247-52.
Vetrone G, Ercolani G, Grazi GL, Ramacciato G, Ravaioli M, Cescon M, et al. Surgical therapy for hepatolithiasis: a Western experience. J Am Coll Surg. 2006;202(2):306-12.
Koh YX, Chiow AKH, Chok AY, Lee LS, Tan SS, Ibrahim S. Recurrent pyogenic cholangitis: disease characteristics and patterns of recurrence. ISRN Surg. 2013;2013:1-9.
Tan HL, Koh YX, Lye WK, Lee SY, Goh BKP, Tan SS, et al. Surgical management decreases disease recurrence risk in recurrent pyogenic cholangitis. Anz J Surg. 2018;88(9):659-63.