REAPPRAISAL OF THE SYSTEMATIC MANAGEMENT OF COMPLICATED HEPATOLITHIASIS WITH BILATERAL INTRAHEPATIC BILIARY STRICTURES

Objective: To compare the results, limitations, and complications of t he surgical treatment of bilateral hepatolithiasis and intrahepatic bi liary strictures with left hepatectomy and without left hepatectomy. D esign: Case-controlled study. Setting: Referral center. Patients: Duri ng a 12-year period, 103 patients with bilateral hepatolithiasis and i ntrahepatic biliary strictures underwent surgical treatment. Group A ( n=73) received left hepatic resection (lateral segmentectomy or lobect omy) and postoperative biliary dilatation with residual stone extracti on. Group B (n=30) underwent the same procedures except for left hepat ectomy. Interventions: Left lateral segmentectomy or left lobectomy, c holedocholithotomy, postoperative cholangioscopic treatments (electroh ydraulic lithotripsy, other lithotripsy, lithotomy, balloon dilatation , etc, via T tube or percutaneous transhepatic route). Main Outcome Me asures: Days of hospitalization, incidence of major and minor complica tions, mortality rates, and the rates of residual stones and stone rec urrence were compared. Results: Groups A and B had similarly low posto perative 1-month mortality rates of 5.5% and 6.7%, respectively. The m ain cause of death in both groups was uncontrollable septicemia. The m ain major complications in group A were intra-abdominal abscess and up per gastrointestinal bleeding; the major complication in group B was m assive hemobilia. Group B had a significantly higher overall rate of c omplications (53.3% vs 23.3%, P<.01) and a longer hospital stay than g roup A (median, 72 days vs 28 days, P<.03). When complications were cl assified as major or minor, only minor complications showed a signific ant difference (30% vs 13.7%, P=.05). After using biliary stricture di latation and stone extraction, the rate of residual stones in the righ t lobe was similar in both groups, but patients in group B had a signi ficantly higher rate of residual stones (12.5% vs 0%, P<.02) and stone recurrence in the left lobe (19% vs 0%, P<.003) than those in group A . Conclusions: Partial resection of the left lobe in cases of bilatera l hepatolithiasis and biliary strictures can effectively simplify prob lems in the treatment of bilateral hepatolithiasis and intrahepatic bi liary strictures. In addition, not only were surgical complications no t increased, but a decrease in complications from postoperative manipu lations for stone clearance was noted in our series.