Hepatic resection for hepatolithiasis

Abstract

Objective: To analyze the results of hepatic resection for hepatolithiasis. Design: A retrospective study of case records of patients with hepatolithiasis undergoing hepatic resection. These patients had been followed up for 3 to 38 months. They were referred to Queen Mary Hospital, a tertiary referral center in Hong Kong. Patients: Of 172 patients with hepatolithiasis seen between January 1984 and December 1981, 63 patients underwent hepatic resection because the affected liver segments were destroyed by repeated infection (n=51), multiple cholangitic liver abscesses were found in the affected liver segments (n=9), or concomitant intrahepatic cholangiocarcinoma was diagnosed (n=3). Intervention: Left lateral segmentectomy was performed in 42 patients, left hepatic lobectomy in 15 patients, right hepatic lobectomy in one patient, and segmentectomy in five patients. Main Outcome Measures: Postoperative morbidity and mortality analysis. Results: Contrary to hepatic resection in a normal liver, dissection to isolate inflow and outflow vasculature was difficult in 52% of cases owing to severe inflammatory fibrosis at the liver hilum, at the umbilical fissure, or at the junction of hepatic vein with inferior vena cava. The operative morbidity rate was 32% and the mortality rate was 2%. The majority of complications were wound infection, subphrenic abscesses, or biliary fistulas, which could be due to the presence of infected bile (85%) and liver abscesses (25%) in this disease. Statistical analysis of the preoperative hematological and biochemical variables and the amount of intraoperative blood loss could not identify any factor with significance in correlating with the development of postoperative complications. Stones recurred in 16% after a median follow-up of 47 months. Conclusion: Hepatic resection is a satisfactory treatment for hepatolithiasis. The postoperative septic complication rate is high and is an intrinsic problem related to liver resection in a septic condition.