Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Jan 21;12(3):431-6.
doi: 10.3748/wjg.v12.i3.431.

Favorable outcomes of hilar duct oriented hepatic resection for high grade Tsunoda type hepatolithiasis

Bong-Wan Kim  1 , Hee-Jung Wang, Wook-Hwan Kim, Myung-Wook Kim
Affiliations

Favorable outcomes of hilar duct oriented hepatic resection for high grade Tsunoda type hepatolithiasis

Bong-Wan Kim et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure (VHE) method that has been applied by the authors.

Methods: From June 1994 to June 2004 for a period of 10 years, 153 patients who had Tsunoda type III or IV hepatolithiasis, received hepatectomy at our institution. Among these patients, 128 who underwent hepatectomy by the VHE method were the subjects for the study. We analyzed the risk of this procedure, residual rate of intra-hepatic stones, and stone recurrent rates.

Results: The average age was 54.2 years, and the male to female ratio was 1:1.7. The average follow-up period was 25.6 mo (6-114 mo). There was no post-operative severe complication or mortality after the operation. The rate of residual stones was 5.4% and the rate of recurrent stones was 4.2%.

Conclusion: VHE is a safe surgical procedure and provides favorable treatment results of intractable hepatolithiasis. Especially, this procedure has advantage in that intra-hepatic bile duct stricture may be confirmed and corrected directly during surgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Schematic drawing of VHE procedure during left lobectomy. A: Hepatotomy commences vertically from the Cantlie’s line to the direction of the hilar bile duct (thick arrow); B: after reaching the hilum, the hepatotomy is continued along the pre-caudate plane (angled thick arrow); C: the ventral portion of the hilar hepatic duct is opened along its direction; D: after completion of the necessary ductal procedure.
Figure 2
Figure 2
A: Dissecting along the pre-caudate plane allows the ventral portion of the hilar duct to be exposed during left lobectomy; B: the hilar duct was opened along its direction; RHD: right hepatic duct opening.
Figure 3
Figure 3
During central lobectomy, the hilar duct was exposed and opened. A: Extraction of the IHD stones; B and C: application of intra-operative choledochoscope to the left and right IHD; D: after the removal of all intra-hepatic stones.
Figure 4
Figure 4
A and B: Pre-operative imaging of hepatolithiasis with hilar duct stricture; C: opened hilar IHD shows narrow entry of right IHD (arrow); D: after stricture-plasty both entries of the right anterior and posterior ducts are seen.
See this image and copyright information in PMC

References

    1. Chen MF, Jan YY, Wang CS, Hwang TL, Jeng LB, Chen SC, Chen TJ. A reappraisal of cholangiocarcinoma in patient with hepatolithiasis. Cancer. 1993;71:2461–2465. - PubMed
    1. Kubo S, Kinoshita H, Hirohashi K, Hamba H. Hepatolithiasis associated with cholangiocarcinoma. World J Surg. 1995;19:637–641. - PubMed
    1. Park YH, Park SJ, Jang JY, Ahn YJ, Park YC, Yoon YB, Kim SW. Changing patterns of gallstone disease in Korea. World J Surg. 2004;28:206–210. - PubMed
    1. Cetta F, Lombardo F, Cariati A. The role of the content (decreased level of apolipoprotein A1) and of the container (bile duct stricture, sectorial dilatation of the ducts determining bile stasis) in the pathogenesis of hepatolithiasis, either pigment or cholesterol. Hepatology. 1994;19:1539–1541. - PubMed
    1. Nakanuma Y, Yamaguchi K, Ohta G, Terada T. Pathologic features of hepatolithiasis in Japan. Hum Pathol. 1988;19:1181–1186. - PubMed