Partial Liver Resection in Hepatolithiasis

Patients with hepatolithiasis have complicated clinical features. Many patients have bilobar involvement and biliary strictures at multiple levels are frequently observed. Treatment of hepatolithiasis should be individualized according to the underlying condition. We reviewed the therapeutic results for hepatolithiasis in 81 patients. Forty-three patients (53.1%) underwent partial resection of the liver, and 38 received non-resectional treatment. Abdominal pain in the right upper quadrant was the most common symptom and history of cholangitis was confirmed in 24 patients (29.6%). Intrahepatic stones were located in the left side of the liver in 40 patients, and 31 patients had stones in both sides of the liver. Left lateral segmentectomy was the most commonly used operation (n=31); other types of hepatic resection were segmentectomy of the right lobe (n=8), left lobectomy (n=3), and right lobectomy (n=1). For the drainage of the biliary outflow, we carried out hepaticojejunostomy with subcutaneous jejunostomy in 14 patients and choledochoduodenostomy in 8 patients. All patients underwent cholangiography and percutaneous choledochoscopic examination post-operatively to confirm the absence of residual stones. Residual stones were detected in 8 patients (6 with biliary drainage alone, 2 with hepatic resection). There was no operation-related mortality. The mean value of the operative time was longer in the patients receiving hepatic resection (216 min. versus 187 min.). There were no significant differences in terms of post-operative complications (6 with biliary drainage alone, 8 with hepatic resection) or hospital stay between the patients who received hepatic resection and those who received non-resectional treatment. In conclusion, partial resection of a diseased liver is an effective treatment for hepatolithiasis in selected patients and does not increase peri-operative morbidities.

A Clinical Study of Surgical Management for Meckel's Diverticulum

Meckel's diverticulum is an embryologic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract, affecting 1% to 2% of the general population. Although this prevalence is relatively low, Meckel's diverticulum is occasionally encountered as an incidental identification during abdominal exploration and can be associated with several life-threatening disease states, such as massive intestinal bleeding, intestinal obstruction, or on rare occasion, perforation. The management of a Meckel's diverticulum found incidentally on laparotomy is controversial because the rate of complications developing from the diverticulum remains uncertain. The data in this report are based on 18 cases of Meckel's diverticulum which were treated at the Department of Surgery, InJe University Sanggye Paik Hospital, during the 7 years between January 1990 and December 1996. The results are as follows: 1) The overall sex ratio of males to females was 5 : 1 and in the symptomatic group, the ratio was 6 : 1. 2) Ninety percent of the patients were under 40 years of age, and 56% were under 10. 3) The diverticula were located from 20 cm to 100 cm proximal to the ileocecal valve, and the average range was 53 cm from the ileocecal valve. Fifteen cases were located at the antimesenteric border, and 3 cases at the mesenteric border of the ileum. 4) The lengths of the diverticula ranged from 1cm to 6cm, and the diameters ranged from 0.5 cm to 4.5 cm. 5) Appendicitis and intestinal obstruction were the most frequent preoperative diagnoses in the symptomatic group. 6) The common complications were intestinal obstruction and inflammation. 7) Heterotopic tissues were found in three patients and all of them were ectopic gastric mucosa. 8) The treatment was a diverticulectomy or a segmental resection of the involved bowel. 9) Postoperative complications were found in three of the asymptomatic group: two early intestinal obstructions and one wound infection.