Korean J Hepatobiliary Pancreat Surg.  2011 Aug;15(3):139-145. 10.14701/kjhbps.2011.15.3.139.

Selection of surgical treatment types for intrahepatic duct stones

• Hong KS
• Noh KT
• Min SK
• Lee HK

• KMID: 2130984
• DOI: http://doi.org/10.14701/kjhbps.2011.15.3.139

Abstract

BACKGROUNDS/AIMS
Complete elimination of intrahepatic duct (IHD) stones is difficult and IHD stone disease is frequently associated with various complications, recurrence and sometimes cholangiocarcinoma. Therefore, we analyzed the long-term surgical results and evaluated the management currently considered appropriate.
METHODS
Overall 110 patients who had been diagnosed with benign IHD stone disease and who underwent surgical treatment were enrolled in this study. The patients were categorized into three groups according to the type of surgery performed; liver resection (LR) group, intrahepatic duct exploration (IHDE) group and hepaticoenterostomy (HE) group. We compared and analyzed the results of these three groups.
RESULTS
The number of cases in the LR group, IHDE group and HE group were 77, 25 and 8 respectively. The LR group required a longer operation time (p=0.000), more frequent transfusion (p=0.028) and had higher morbidity (p=0.049). However, the LR group had a higher clearance rate (90.9%) (p=0.000) than the other groups. In addition, there were a total of 22 cases of IHD stone recurrence during the follow-up, but there was no statistically significant difference among the three groups. The location of IHD stones was related to a risk factor for incomplete stone removal, but not for recurrence.
CONCLUSION
The fundamental principle for the treatment of IHD stone disease should be liver resection. However, it can lead to a longer operative time and higher rate of complications than the other procedures. There is also no difference in the IHD stone recurrence rate among the procedures. Therefore, these alternative and minor procedures could also be taken into account for patients with poor preoperative condition.

Keyword

Intrahepatic duct stones; Liver resection; Intrahepatic duct exploration; Hepaticoenterostomy

MeSH Terms

Cholangiocarcinoma
Follow-Up Studies
Humans
Liver
Operative Time
Recurrence
Risk Factors

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