Hepatolithiasis: Current management

Abstract

The early results from 50 patients with hepatolithiasis managed in the last three years by a systematic and aggressive approach were analysed. The patients were evaluated thoroughly before surgery by direct cholangiography, ultrasonography and computed tomography. Compared with our previous studies, the clinical features of the patients were similar, but there was a higher incidence of concomitant cholangiocarcinoma (14% of the present series versus 3% of the past series). Hepaticocutaneous jejunostomy, partial hepatectomy or a combination of these two major procedures was performed in 90% of the cases. Residual stones were found in only 16% of cases after operation and complete eradication of residual stones was achieved in all patients by postoperative choledochoscopy. On follow-up (mean 10 months, range one to 34 months), recurrence of stones developed in one patient only and was due to development of a hilar cholangiocarcinoma. In conclusion, the early results of treatment of hepatolithiasis in recent years are satisfactory.