HEPATIC RESECTION FOR HEPATOLITHIASIS AND LONG-TERM RESULTS

BACKGROUND: Hepatic resection is an established procedure for treating patients with hepatolithiasis. The long-term results after hepatic re section for hepatolithiasis were appraised. STUDY DESIGN: Of 127 patie nts with hepatolithiasis seen between 1973 and 1993, 43 patients under went hepatic resection, and constituted the basis of this study. RESUL TS: There was one operative death (operative mortality rate of 2.3 per cent) and three deaths as a result of concomitantly associated cholang iocellular carcinoma, Of the remaining 39 patients, the complete stone clearance rate was 67 percent with operation alone, but reached 87 pe rcent when cholangioscopy was used. Operative morbidity was recorded i n five patients (12 percent), but they recovered with conservative the rapy. Stones recurred in 15 percent of patients after a mean follow-up period of four years (range of three to six years). Eleven (28 percen t) of 39 patients died after hepatectomy as a result of related diseas es after a mean follow-up of 6.2 years. These II patients had associat ed biliary drainage procedures. They experienced a higher mortality ra te (p<0.05) than patients who did not have biliary drainage. CONCLUSIO NS: We conclude that hepatic resection is adequate treatment for hepat olithiasis. The patients having additional biliary drainage procedures had a higher mortality, but one cannot reach conclusions about the ne gative effect of the drainage procedures because the drainage procedur es were done in a selected and not a randomized manner.