Intrahepatic stones are difficult to manage, especially they are associated with bile duct stricture, cholangitis and destruction of liver parenchyma. There are several suggested methods of treatment which include surgical bile duct exploration
with or
without biliary drainage, endoscopic procedures, transhepatic cholangiolithotomy and liver resection. Surgeons must consider the extent of atropy of liver parenchyma, existence of extrahepatic gallstone and nature of intra and extrahepatic
biliary
tree
to choose the type of operation in primary hepatolithiasis.
We underwent 20 cases of left lateral segmentectomy for primary hepatolithiasis from Jan. 1992 to April. 1995 in Seoul City Bora,ae Jospital. The indication of resection was atropy of lateral segment(n=14) and stricture of bile duct(n=6). Most of
the
patients were female (n=16) and the mean age was 46.6(31~64). Concomitant CBD exploration was performed in 18 cases and among them 13 cases had cholodocholithiasis. Cholecystectomy was performed in 15 cases and among them 3 cases had gallstones.
4
cases
had previous operation history related to biliary stones, cholecystecomy(CS) and T-tube choledocholithotomy (TTCL) (n=3), CS+TTCL+choledocheenterostomy (n=1). Residual stone was confirmed with T-tube cholangiography (TTC) and USG and 5 cases had
residual stones. Residual stones located at both duct were managed with stone basket successfully in 1 cases and incomplete removal in 1 case (left duct only). The other 3 cases(Rt=2, Lt.=1) were left without treatment and during the follow-up
period,
left duct stones were disappeared and 1 case of right duct stones caused intermittent cholangitis symptom and 1 case was asymptomatic. The majority of the stone was calcium bilirubinate stone(n=18) and cholesterol stone was absent. 6 cases had
abnormal
LFT preoperatively and all of them returned to normal postoperatively except one who had right duct residual stones. There was no mortality and no reoperation, but morbidity was 42%(n=8) (ARF=1, bleeding=1, bile leakage=1, right subphrenic
abscess=1,
atelectasis=1, wound problem=3).
Left latercl segmentectomy is a satisfactory treatment for hepatolithiasis (75%) in selected patients and if residual stones are present, aggressive endoscopic treatment must be considered for prevention of recurrent cholangitis symptom.
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