Analysis on the Clinical Significance of Biliary Exploration through the Left Hepatic Duct Opening during Left Hepatectomy for the Patients with Hepatolithiasis

ABSTRACT

PURPOSE: Left-sided hepatolithiasis has been often treated by left hepatectomy and bile duct exploration. Choledochotomy has been the preferred route for conducting exploration of the biliary system, and a T-tube has been routinely inserted. As the left hepatic duct opening can be an alternative route for bile duct exploration instead of choledochotomy, we analyzed the clinical usefulness of this alternative access route by performing a prospective study. METHODS: 42 consecutive cases of left hepatectomy for left- sided or bilateral hepatolithiasis were performed by one surgeon between January 2000 and June 2002. The left hepatic duct opening was the preferred access route for bile duct exploration. Choledochotomy was done only for large stone removal, variant biliary anatomy and intentional T-tube insertion for residual intrahepatic duct stone. RESULTS: Consecutive 42 left hepatectomies did not result in any serious surgical complications except for infection. Choledochotomy could be omitted for 35 of 42 patients and a T-tube was inserted in 7 patients. Residual right lobe stone was removed by choledochoscopy through the T-tube tract in 2 patients. On the 5 year follow-up, only one patient had to undergo percutaneous transhepatic stone removal due to the recurrence of hepatolithiasis. CONCLUSION: We think that bile duct exploration through the left hepatic duct opening is a reasonable and useful method to avoid choledochotomy and T-tube insertion for the patients with left-sided hepatolithiasis.