A Study of Factors Related to Recurrent Stones after Surgical Treatment of Hepatolithiasis

ABSTRACT

PURPOSE: Hepatolithiasis, which is located in proximal sites of the common hepatic bile duct, is a common disease in Korea. Hepatectomy is a more effective treatment for achieving complete removal of stones and biliary strictures. However, the incidence of remnant or recurrent stones is still high. The aim of this study was to evaluate factors related to the recurrence of stones after surgical treatment of hepatolithiasis. METHODS: From February 1999 to February 2009, we conducted a retrospective study of case records of 208 patients who underwent operations for hepatolithiasis at the Department of Surgery, Chonbuk National University Hospital. RESULTS: The male to female ratio was 11.97; the mean age was 55 years. Hepatolithiasis was located in the left intrahepatic duct in 69.7% of patients, in the right intrahepatic duct in 14.4%, and in both ducts in 15.9%. Operative procedures were as follows left lateral sectionectomy in 109 (52.4%), left hemihepatectomy in 26 (12.5%), posterior sectionectomy in 5 (2.4%), a right hemihepatectomy in 8 (3.8%), a choledocholithotomy in 38 (8.6%), a choledocho-enterostomy in 18 (8.6%), a choledochotomy in 1 (0.46%), a choledochal cyst excision in 1 (0.46%), and no primary operation in 2 (0.9%). Complete stone clearance was achieved in 76% after operative treatment. Biliary stricture was significantly associated with remnant stones (p=0.000). In addition, the incidence of recurrent stones was 15.3%. Recurrent stones were associated with biliary stricture (p=0.001), hepatectomy (p=0.003), and bilateral location of stones (p=0.016). During the follow up period, the mortality rate related to operative treatment was 0.96%. CONCLUSION: Biliary stricture, hepatectomy, and bilateral location of stones are associated with recurrent hepatolithiasis after surgery.