Hepatolithiasis: clinical series, review and current management strategy

Abstract

Objective: Hepatolithiasis (HL) continues to be a problem due to its local and systemic complications, insufficiency in treatment modalities and high risk of recurrence. There are various surgical options available, ranging from endoscopic interventions to a small segment resection and ultimately to transplantation. In this article, patients with the diagnosis of HL and our treatment strategies were evaluated in the light of literature. Material and Methods:The patients diagnosed with HL in our clinic between 2014-2019 were evaluated retrospectively by examining the patient files. Demographic characteristics of the patients, causes of the disease, complications and treatment options were evaluated.Results: 17 patients were included into the study. Mean age of the patients was 64.3 years (range 32-89 years). Seven patients had previous cholecystectomies. Stenosis was found to be developed in hepaticojejunostomy (HJ) site in three patients (two had HJ due to bile duct injury and one had HJ following the Whipple procedure), and in hepaticoduodenostomy site in one patient who had the history of biliary tract injury during cholecystectomy. Two patients with HL without previous cholecystectomies had no gallbladder stones. Nine patients underwent surgery. Left hepatectomy was performed in two patients and lateral sector resection was performed in 2 patients. Two patients with anastomotic stenosis underwent HJ revision and two patients with anastomotic stenosis and one patient with stent ingrowth underwent bifurcation resection and neo-hepaticojejunostomy. Eight patients were followedup nonoperatively with medical and endoscopic approaches. Conclusion:Hepatolithiasis is a serious condition that needs to be treated with a multimodal approach. Stenting and anastomotic stenosis facilitate the development of hepatolithiasis and increase the risk of its occurrence. In particular, by performing functional hepaticojejunostomy, the development of this complication will be decreased.

Ultrasound-guided percutaneous transhepatic one-step biliary fistulation combined with rigid choledochoscopy for recurrent hepatolithiasis

“…The treatment of RHL is currently still surgical, and the main treatment modalities include hepatectomy, PTCS, choledochojejunostomy, endoscopic lithotripsy, with the aim of removing stones, relieving stenosis, and patrolling drainage [ 19 , 20 ]. Among them, hepatectomy is considered the first choice for the treatment of HL, but in patients who have a wide distribution of stones, partial hepatectomy is limited, and it is often required to be combined with other surgical procedures [ 3 , 18 ]. Li performed hepatectomy combined with cholangioscopy for stone extraction in 56 patients with HL, stone clearance and recurrence rates were 92.9% and 13.5%, and 26.8% of patients experienced postoperative complications [ 21 ].…”

“…Hepatolithiasis (HL) is very common in East Asia, with an incidence of 30% -50%, while in Western countries, the number is only 0.6% -1.3% [ 1 , 2 ]. In recent years, with the changes in economic conditions as well as dietary habits, the incidence of HL in Eastern countries has declined, while the incidence in Western countries is gradually increasing with the increase of Asian immigrants [ 1 , 3 ]. The mechanism of HL formation remains to be further elucidated and is generally considered closely related to infection, bile duct stenosis, and anatomical abnormalities [ 3 , 4 ].…”

Outcomes of laparoscopic choledochotomy using cholangioscopy via percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis: A preliminary Vietnamese study

“…In our study, retained stones were associated with biliary strictures (odds ratio, 16.00; 95% confidence interval, 4.01–63.86; p < 0.001) which is consistent with results of multiple previous studies [ 18 , 19 ]. These lesions may need to be intervened with biliary stenting or bypass procedures such as Roux-en-Y hepaticojejunostomy [ 20 ].…”

Photo-crosslinked adhesive hydrogel loaded with extracellular vesicles promoting hemostasis and liver regeneration

“…Hepatectomy is an operation to remove local lesions in the liver, including liver tumors, liver trauma, liver abscess, and intrahepatic bile duct stones, etc ( Quan et al, 1996 ; Chang et al, 2006 ; Longmire and Tompkins, 2012 ; Graham et al, 2018 ; Dilek et al, 2020 ). Although the liver itself has a regenerative function, patients suffering from diseases such as fatty liver or cirrhosis can severely affect postoperative liver function compensation and liver regeneration.…”