ROLE OF RIGHT HEPATIC LOBECTOMY IN THE TREATMENT OF ISOLATED RIGHT-SIDED HEPATOLITHIASIS

Background. The role of right hepatic lobectomy is evaluated in the tr eatment of selected patients with isolated right-sided hepatolithiasis . Methods. During the past 7 years right hepatic lobectomy was perform ed in five patients who had isolated right-sided hepatolithiasis. The rationale and indications of this procedure are discussed. The efficac y of preoperative evaluations, the operative findings, and the operati ve results are analyzed. Results. All the patients were female with a mean age of 49.2 years (range, 33 to 63 years). The main symptoms were upper abdominal pain (n = 5), fever (n = 4), and jaundice (n = 2). Th e mean operative time was 166.4 minutes, and the mean blood loss was 8 80 ml. The complete stone clearance rate was 100%. No operative deaths occurred. Right subphrenic abscess with reactive pleural effusion dev eloped in two patients. Echo-guided percutaneous drainage was applied to one patient, and no surgical intervention was needed. The mean foll ow-up period from the treatment was 13.4 months (range, 6 to 18 months ), During the follow-up period no stone recurrence was found. Conclusi ons. Right hepatic lobectomy is indicated in patients who have localiz ed right-sided hepatolithiasis with irreversible biliary stricture inv olving the right hepatic duct, an atrophied right lobe of the liver, m ultiple cholangitic abscesses, or possible presence of cholangiocarcin oma. Preoperative evaluations, including cholangiography, abdominal ul trasonography, and computed tomography, are important for the accurate selection of patients and successful treatment.