Surgical management of hepatolithiasis

Abstract

Background: Globalization and intercontinental migration have not just changed the socioeconomic status of regions, but have also altered disease dynamics across the globe. Hepatolithiasis, although still rare, is becoming increasingly evident in the West because of immigration from the Asia-Pacific region, where the disease prevails in endemic proportions. Such rare but emerging diseases pose a therapeutic challenge to doctors.

Methods: Here, we briefly introduce the topic of hepatolithiasis and describe features of intrahepatic stones, the aetiology of hepatolithiasis and the symptoms and sequelae of the condition. We then provide a comprehensive review of the various management modalities currently in use to treat hepatolithiasis.

Conclusions: In our opinion, and as is evident from the literature, surgery remains the definitive treatment for hepatolithiasis. However, non-surgical procedures such as cholangiography, although limited in their therapeutic capabilities, play a vital role in diagnosis and preoperative evaluation.

Keywords: hepatectomy; hepatolithiasis; percutaneous transhepatic cholangiography.

Figure 2

Magnetic resonance imaging of the abdomen revealing dilated intrahepatic ducts with filling defects in segment II of the liver, highly suggestive of stones or debris

Figure 1

Computed tomography scan of the abdomen showing multiple dilated bile ducts in the lateral segment (segment II) of the left hepatic lobe

Figure 3

Endoscopic retrograde cholangiopancreatography demonstrating (A) extrabiliary opacification in the left liver, dilated common bile duct (CBD) and left intrahepatic ducts with multiple lucencies of various sizes, and (B) markedly dilated CBD and left intrahepatic ducts with ductal branch irregularity indicative of stones or tumours

Figure 4

(A) Preoperative percutaneous transhepatic cholangiography revealing filling defects in significantly dilated common bile duct and left intrahepatic ducts indicative of stones. (B) Postoperative T-tube cholangiogram revealing no obstruction with free flow of contrast into the duodenum

Figure 5

(A–C) Preoperative percutaneous transhepatic cholangiography images demonstrating dilated common bile duct and left intrahepatic ducts with numerous filling defects compatible with stones or debris

Figure 6

Management algorithm for hepatolithiasis. US, ultrasound; CT, computed tomography; MRI, magnetic resonance imaging; ESWL, extracorporeal shock wave lithotripsy; PTC, percutaneous transhepatic cholangiography; PTCSL, percutaneous transhepatic cholangioscopic lithotomy or lithotripsy, CBD, common bile duct