Problems and strategies on perioperative assessment and management in liver resection for primary hepatolithiasis / 国际外科学杂志

ABSTRACT

Ductal strictures, recurrent cholangitis, liver atrophy or hepatic abscess, and ultimate cholangiocarcinoma are the major pathological entities of primary hepatolithiasis. Because of distinctive bile ductal lesion and hepatic tissue inflammation, liver resection indicated for hepatolithiasis should have different emphasis on perioperativer assessments and managements from hepatectomy for liver cnacer. Preoperative assessment should focus on the feasibility of precise hepatectomy for good long-term outcome. Percutaneous bile duct drainage is considered preferentially for patients with cholangitis. Attention should be paid to avoiding major blood loss, postoperative bile leakage and infectious biloma formation in surgical steps such as hepatic hilum dissection, liver parenchymal transection, bile duct exposure, bile duct stump closure and drainage of liver raw surface. The indication for biliary reconstruction should be based on the estimation of function of the Oddi sphincter. For residual hepatolithiasis, choledochoscopical trans-T tube stone withdraw should carried out 3 months postoperatively in prevention of laceration of T-tube fistula.