Hepatic resection for hepatolithiasis
S. T. Fan, E. C. Lai and J. Wong
Department of Surgery, Queen Mary Hospital, University of Hong Kong.
OBJECTIVE: To analyze the results of hepatic resection for hepatolithiasis.
DESIGN: A retrospective study of case records of patients with
hepatolithiasis undergoing hepatic resection. These patients had been
followed up for 3 to 38 months. They were referred to Queen Mary Hospital,
a tertiary referral center in Hong Kong. PATIENTS: Of 172 patients with
hepatolithiasis seen between January 1984 and December 1981, 63 patients
underwent hepatic resection because the affected liver segments were
destroyed by repeated infection (n = 51), multiple cholangitic liver
abscesses were found in the affected liver segments (n = 9), or concomitant
intrahepatic cholangiocarcinoma was diagnosed (n = 3). INTERVENTION: Left
lateral segmentectomy was performed in 42 patients, left hepatic lobectomy
in 15 patients, right hepatic lobectomy in one patient, and segmentectomy
in five patients. MAIN OUTCOME MEASURES: Postoperative morbidity and
mortality analysis. RESULTS: Contrary to hepatic resection in a normal
liver, dissection to isolate inflow and outflow vasculature was difficult
in 52% of cases owing to severe inflammatory fibrosis at the liver hilum,
at the umbilical fissure, or at the junction of hepatic vein with inferior
vena cava. The operative morbidity rate was 32% and the mortality rate was
2%. The majority of complications were wound infection, subphrenic
abscesses, or biliary fistulas, which could be due to the presence of
infected bile (85%) and liver abscesses (25%) in this disease. Statistical
analysis of the preoperative hematological and biochemical variables and
the amount of intraoperative blood loss could not identify any factor with
significance in correlating with the development of postoperative
complications. Stones recurred in 16% after a median follow-up of 47
months. CONCLUSION: Hepatic resection is a satisfactory treatment for
hepatolithiasis. The postoperative septic complication rate is high and is
an intrinsic problem related to liver resection in a septic condition.
