Resection of extrahepatic bile ducts with partial hepatectomy for treating intra- and extrahepatic hepatolithiasis

Abstract

Background To evaluate the efficacy and safety of our new surgical procedures for primary intra- and extrahepatic hepatolithiasis. Hepatolithiasis is an intractable disease with frequent recurrences. Methods From 1996 to 2005, 142 patients with intrahepatic and/or extrahepatic hepatolithiasis treated with the conventional surgical methods were included as the control group, while 128 consecutive patients treated with new surgical methods from 2006 to 2015 were included as the observation group. The new surgical procedures included a comprehensive intraoperative exploration of the bile ducts, focusing on the structure and function of the hilar bile duct and duodenal papilla, exploration of the affected liver, and bile culture. Results The observation group had a significantly higher complete stone clearance rate than the control group (100% vs. 65.96%). The observation group had significantly lower incidences of cholangitis and bile duct stones, as well as a higher excellent and good long-term surgical efficacy rate (86.24% vs. 52.73%). Multivariate Cox analysis showed that the control group had a higher risk for fair + poor efficacy than the observation group (HR: 8.47). Conclusions Our new surgical procedures are safe and can provide a good long-term efficacy for treating primary hepatolithiasis intra- and extrahepatic hepatolithiasis.

Surgical Management of Recurrence of Primary Intrahepatic Bile Duct Stones

“…Another consideration is the extent of the affected liver. If the affected liver has obvious fibrosis, atrophy, and evidence of ischemia or cirrhosis and normal function will not be restored after stone removal, obstruction elimination, and the establishment of proper bile duct flow, a partial hepatectomy should be performed [ 23 , 24 ]. On the other hand, in mild disease, partial hepatectomy is not required when the function can be restored after stone removal and the establishment of proper bile duct flow.…”

Clinical Value Analysis of Hepatectomy Based on Minimally Invasive Surgical Imaging for Hepatolithiasis

“…The most effective treatment for patients with hepatobiliary calculi is partial hepatectomy, which can remove the stones, remove the narrow area of the bile duct and the atrophic liver parenchyma, thereby reducing the risk of stone recurrence [ 4 ]. Open hepatectomy is effective but invasive to patients.…”