Indocyanine green retention test avoiding liver failure after hepatectomy for hepatolithiasis

Abstract

Background/aims: To investigate the role of indocyanine green (ICG) retention test in avoiding postoperative liver failure after hepatectomy for primary hepatolithiasis.

Methodology: Between January, 2004 and December, 2010, 144 patients with primary hepatolithiasis undergoing hepatectomy were retrospectively selected for the study. Eighty-two of those (Group CP) were preoperatively evaluated only by Child-Pugh (CP) scoring to select candidates for hepatectomy before September, 2008. Since then ICG15 retention test was accepted for the same purpose in the remaining 62 cases (Group ICG).

Results: The immediate stone clearance rates were 79.27% and 80.65%, with final stone clearance rates 93.9% and 93.55% in the CP and ICG groups, respectively. Liver failure was observed significantly more in the CP (12.2%) than that in the ICG group (1.61%), (p<0.05). More hospital deaths occurred in the CP (4.88%) than in the ICG group (1.61%), although no significant difference was observed (p=0.548). The complication rate of the CP group (37.80%) was significantly higher than that of ICG group (17.74%), (p<0.05).

Conclusions: ICG15 retention test is more effective to predict and avoid liver failure for patients with hepatolithiasis after hepatectomy than CP scoring system. It may also decrease the morbidity and mortality rate through strict selection, thus increasing operative safety.