Clinical Review of the Hepatic Resection for Hepatolithiasis: Factors Affecting Postoperative Complications / 한국간담췌외과학회지

ABSTRACT

PURPOSE: The hepatolithiasis and associated cholangitis result in liver atropy, biliary stricture, liver abscess and intrahepatic malignancy, and a hepatic resection should be performed in such cases. The technical difficulty and accompanied inflammation with a hepatic resection frequently cause postoperative complications. Therefore, the factors affecting the postoperative complications were evaluated. METHODS: Twenty one patients, with hepatolithiasis that had received a hepatectomy at the Department of Surgery, Eulji University Hospital between March 2001 and January 2003, were reviewed. RESULTS: The postoperative complications were intraabdominal abscess (7 cases), pleural effusion (3 cases), wound complication (3 cases), T-tube site leakage (1 case), cardiac arrest (1 case), acute pancreatitis (1 case), hepatitis A (1 case) and delayed gastric emptying (1 case). The overall complication rate was 57% (12/21 patients) and the most common complication was an intraabdominal abscess (7 cases). The factors that may affect these complications were analyzed. Preoperative percutaneous transhepatic biliary drainage (PTBD) increased the postoperative complications, which was statistically significant (p=0.027). Especially, preoperative PTBD and hepaticojejunostomy increased the rate of an intraabdominal abscess, which was statistically significant (p=0.026, p=0.008). CONCLUSION: With hepatolithiasis requiring hepatic resection there is a need to avoid unnecessary preoperative PTBD and bypass surgery for the reduction of postoperative complications, including an intraabdominal abscess. Conversely, it is considered important to remove every stone and avoid needless bypass surgery under an operation and for a hepatic resection to be performed after removing PTBD, where possible.