Intrahepatic stone, or hepatolithiasis, has long been a challenge to surgenos in East Asia, including our country. The treatment of it is often difficult and repeated operative interventions are often necessary. The results of surgical treatment
in
60
patients with intrahepatic stones seen at the Department of Surgery, Taegu Fatima Hospital from July 1987 to June 1992 are reported including a follow-up study them.
1) The incidence of intrahepatic stones was 11.4% of the patints operated on for cholelithiasis.
2) The peak incidence of age was noted in the 6th decade (38.8%), and the female was more commoly affected than male by the ratio of 1:4.
3) The stones were found in the left hepatic duct in 27 cases (45.0%), in the right duct in 10 cases (16.7%), and in both ducts in 23 cases (38.3%).
4) Operative procedures included removal of stones with T-tube drainage (26.7%), removal of stones with biliary drainage procedures (45.0%) such as choledochoduodenostomy, Roux-en-Y choledochojejunostomy, or transduodenal sphincteroplasty, and
hepatiec
resection with or without drainage procedure (28.3%).
5) The remained stones were noted in 43.3% of the pateints, and higher incidence were noted in patients underwent removal of stones with T-tube drainage and removal of stones with biliary drainage procedure than pateints underwent hepatic
resection.
6) Follow-up study for 6 months to 6 years showed good or fair results in 73.4% of the patients. Hepatic resection with or without drainage procedure revealed the most excellent results and removal of stones with Roux-en-Y choledochojejunostomy
was the
next one showing excellent results at follow-up.
7) Postoperative complication swere noted in 18 cases (30.0%), and the most common one was wound infection but there was no intraoperative or postoperative death.
In our experience, the most satisfactory results have been derived from hepativ resection in the few patients whom it has been possible and removal of stones with bilioenterostomy has been showed the second best results. In conclussion,
intrahepatic
stone is one of the most difficult conditions encountered by surgeons. Although successful application has been reported with each of various technique for management of intrahepatic stones, we found that a combination of various techniques for
management of intrahepatic stones, we found that a combination of several treatment modalities is required for a large part of the patients with intrahepatic stones to achieve optimum results.
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