Intrhepati duct stone(HIS) present serious health problem in East Asian countries including Korea because recurrent or residual stones are common and patients frequently suffer from hepatic damge caused by longstanding obstructive jaundice,
cholangitis,
liver abscess and septicemia. Among various surgical procedures performing in intrahepatic stone, hepatic resection is known as most definitive procedure especially in patients with ductal stricture, but its incidence of postoperative
complication
and
residual or recurrent stone is still high.
We analyzed early and late complications according to type of hepatic resections in HIS(38 cases) and also determined the predisposing factors related to complications.
Male patient was 15 cases and female was 23 cases, median age was 47 years(ranged 29 to 70 years). Hepatic resection was made in 54% of all operated HIS patients. Postoperative median duration of follow up was 26 months(ranged 1 month to 72
months),
Common clinical manifestation were RUQ or epitastric pain and tenderness (100%), fever or chill(39%), nausea and vomiting(25%), and jaundice(25%). Location of HIS was left in 25 cases(66%), right in 12 cases(31%), both in 1 case(3%), and 27
cases(71%)
had concomittent extrahepatic duct stone. Type of hepatic resection was left lateral segmentectomy in 19 cases(50%), left lobectomy in 16 cases(42%) anf right lobectomy in 3 cases(8%). Postoperative complications were biliary fistula(26%), wound
infection(16%), pleural effusion(13%), acute renal failure(8%), in order of requency. Overall early complication rate was 55% and it was increased by extension of hepatic resection (p<0.05) and preoperative bilirubin level, although statistically
not
significant, but unrelated to age, sex or other liver function test.
Overall incidence of residual or recurrent stone was 39% and it was higher in patients with left laterla segmentectomy and without biliary drainage procedure although statistically not significant. The postoperative mortality was 8%(3 cases).
These results lead to conclusion that hepatic resection canbe a curative therapy in the treatment of IIIS but intensive preoperative biliary decompression androutine use of intraoperative cholangioscopy should be established to minimize the
incidence of
postoperative complication or mortality and residual stone, respectively.
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