Morphology of intrahepatic duct in surgical treatment of hepatolithiasis.

Background/Aims: Surgery is the usual treatment for hepatolithiasis. However, the method of choice is based on intrahepatic duct morphology. Material and Methods: Six hundred sixty-two patients with hepatolithiasis were operated on in the period between 1980-1994. Hepatolithiasis was clinically classified into primary (75.8%) and secondary (24.2%) types. Results: Patients treated between 1990-1994 (35.9%), liver resection was performed in 71 patients (69 of left and 2 of the right liver). However, liver resection was chosen only in 6.7% (11/163) during the 1970s. Candidacy for liver resection increased recently due to the increase in primary type. According to the morphology of intrahepatic ducts, the location of stricture was classified into: Central type (n=59, 30%), Segmental type (n=101, 51%), and Subsegmental type (n=21, 10.6%), and unclassified (n=17, 8.4%). Liver resection was recommended for patients of segmental or subsegemental type. Choledocho-lithotomy with T-tube drainage was indicated in two third of the patients with hepatolithiasis. However, the incidence of post-operative retained stones was very high, and post-operative choledochoscopic lithotripsy was used to treat these post-operative problems easily. The mortality of this disease was 1% (2/198) in the 1990s compared with that of 4.1% (19/464) in 1980s and 10.1% (15/148) in 1970s. Conclusion: We strongly recommend that liver resection for patients with adequate indications will have good results. In addition, one should pay attention to the abnormal pattern of intrahepatic ducts that are commonly found in patients with hepatolithiasis during liver resection. Liver resection is an ideal surgical method for the eradication of diseased lesions and to prevent malignant changes from bile duct with stones. Concise information concerning the anatomic structure was found to be important in determining post-operative results in the management ofhepatolithiasis.