Feasibility of Left Hemi-hepatectomy for the Treatment of Left Intrahepatic Duct Stones

ABSTRACT

PURPOSE: The definite modality for the treatment of intrahepatic duct stones (IHS) is a hepatic resection, which can achieve two goals; removal of the stones and stricture of the bile duct, thus reducing the risk of recurrent intrahepatic duct stones. As a procedure, a left lateral sectionectomy has usually been applied, according to the disease location. However, in patients having had a left lateral sectionectomy, the postoperative results have shown increased complication rates. In this study, we investigated the better results of a left hemi-hepatectomy compared to a left lateral sectionectomy for the treatment of left IHS in terms of postoperative complications. METHODS: Thirty two patients, who were treated with a hepatic resection for their IHS, between January 2001 and November 2003, were analyzed. The patients were divided into two groups according to the operative procedure, as follows; group I had a left lateral sectionectomy and group II a left hemi-hepatectomy. The amount of bleeding, duration of surgery, postoperative results and complications were compared between the two groups. RESULTS: There were 22 and 10 females and males, respectively, with a mean age of 56.9 (+/-10.0) years. Of the patients, 14 and 18 were placed into groups I and II, respectively. The duration of surgery in groups I and II were 220.0 (+/-41.6) and 255.0 (+/-49.8) minutes, respectively. The volume of bleeding was 294.6 (+/-345.5) and 406.0 (+/-177.0) ml in groups I and II, respectively (p> 0.05). The incidence of complications (bile leakage, abscess and occurrence of inflammatory pseudotumors) after a left hemihepatectomy were significantly lower than those after a left lateral sectionectomy (p< 0.05). CONCLUSION: This study revealed that a left lateral sectionectomy has greater complications compared to a left hemihepatectomy for the treatment of left IHS. This may be caused by anatomic variations in bile duct drainage from the left medial segment. If the anatomy of the medial segmental duct was not identified preoperatively, a standard left hemi-hepatectomy should be considered.