Hepatic Resection for Right-Sided Intrahepatic Stones

ABSTRACT

PURPOSE: Hepatic resection is generally considered as the most satisfactory treatment for patients having intrahepatic stones. Yet for cases of right-sided intrahepatic stones, role of hepatic resection is still ambiguous because of the higher operative risks that are entailed when performing surgery at that location. This report presents the results of hepatic resection for the treatment of right-sided intrahepatic stones. METHODS: Seventy-one patients with right-sided intrahepatic stones were operated on during a period of 14 years. The operative procedures executed in the patients were 40 hepatic resections and 31 biliary lithotomies. We analyzed the operative findings and the results of treatment were then compared between the two treatment groups. RESULTS: The intrahepatic bile duct changes associated with stones were cholangitis (n=16), biliary stricture (n=31), biliary dilatation (n=13), and liver atrophy (n=11). Biliary dilatation and liver atrophy were more frequently observed in patients with hepatic resection (p< 0.05). Operative complications occurred in 6.5% of patients after biliary lithotomy and in 25.0% of patients after hepatic resection. There was no operative mortality in both groups. Retained stones were found in 51.6% of patients after biliary lithotomy. There were no retained stones in patients undergoing hepatic resection. After biliary lithotomy, the rate of retained stones was higher for patients having associated bile duct strictures and dilatations (cholangitis; 18.2%, stricture; 64.7%, dilatation; 100%, p< 0.05). Recurrent stones were found to have developed in 10 patients (14.2%), yet the rates for the recurrent stones were not different in both groups. CONCLUSION: Hepatic resection is an effective and safe treatment for right-sided intrahepatic stones. For intrahepatic stones associated with definite bile duct strictures, hepatic resection is the most suitable procedure for the complete removal of stones.