Surgical Experience with Intrahepatic Duct Stones

ABSTRACT

BACKGROUND: Stones in the biliary tree situated proximal to the origin of the common hepatic duct are considered intrahepatic duct stones. This condition causes serious problems, including cholangitis, obstructive jaundice and liver abscess. METHODS: This study was a clinical review of the results from 178 patients with intrahepatic stones who were surgically treated at the Department of Surgery, Gyeongsang National University Hospital from January 1991 to December 1997. RESULTS: The sex ratio of males to females was 12.1, and the most prevalent age group was the 6th decade. Common symptoms and signs were RUQ pain (83.2%) and tenderness (64.7%). Common laboratory findings were elevated alkaline phosphatase (56.6%), elevated serum GOT (47.4%), leukocytosis (44.5%) and hyperbilirubinemia (36.4%). C. sinensis was identified in 22 (12.4%) of the operation cases. Intrahepatic stones were located in the left hepatic duct in 87 cases (48.9%), the right duct in 27 cases (15.2%), and both intrahepatic ducts in 64 cases (35.9%). A partial hepatectomy was performed in 94 cases (52.8%); other procedures without a hepatectomy were performed in 84 cases (47.2%). The remaining stones were noted in 57 (32%) of the operation cases. Among them, 39 cases (68%) were in the non-hepatic resection group, and 18 cases (32%) were in the hepatic resection group. The postoperative complication rate in hepatic resection group (29.8%) was higher than that in the non-hepatic resection group (15.5%). The most common complication was wound infection. The operative mortality was 2.1% in the hepatic resection group and 2.4% in the non-hepatic resection group. The follow-up study showed that 146 cases (82%) were graded as a good result, 7 cases (3.9%) as fair, and 25 cases (14%) as poor and that the relative incidence of good results in the hepatic resection group(88.3%) was higher than that in the non-hepatic resection group (75%). CONCLUSIONS: We conclude that a hepatic resection, rather than a biliary bypass procedure alone, is satisfactory as an initial treatment for hepatolithiasis.