Hepatolithiasis: clinical series, review and current management strategy
Osman Nuri Dilek1, Ahmet Atasever1, Nihan Acar1, Şebnem Karasu2, Emine Özlem Gür1, Oğuzhan Özşay1, Hakan Çamyar3, Fatma Hüsniye Dilek4
1Department of Surgery, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
2Department of Radiology, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
3Department of Gastroenterology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
4Department of Pathology, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
Objective: Hepatolithiasis (HL) continues to be a problem due to its local and systemic complications, insufficiency in treatment modalities and high risk of recurrence. There are various surgical options available, ranging from endoscopic interventions to a small segment resection and ultimately to transplantation. In this article, patients with the diagnosis of HL and our treatment strategies were evaluated in the light of literature.
Material and Methods: The patients diagnosed with HL in our clinic between 2014-2019 were evaluated retrospectively by examining the patient files. Demographic characteristics of the patients, causes of the disease, complications and treatment options were evaluated.
Results: 17 patients were included into the study. Mean age of the patients was 64.3 years (range 32-89 years). Seven patients had previous cholecystectomies. Stenosis was found to be developed in hepaticojejunostomy (HJ) site in three patients (two had HJ due to bile duct injury and one had HJ following the Whipple procedure), and in hepaticoduodenostomy site in one patient who had the history of biliary tract injury during cholecystectomy. Two patients with HL without previous cholecystectomies had no gallbladder stones. Nine patients underwent surgery. Left hepatectomy was performed in two patients and lateral sector resection was performed in 2 patients. Two patients with anastomotic stenosis underwent HJ revision and two patients with anastomotic stenosis and one patient with stent ingrowth underwent bifurcation resection and neo-hepaticojejunostomy. Eight patients were followed-up nonoperatively with medical and endoscopic approaches.
Conclusion: Hepatolithiasis is a serious condition that needs to be treated with a multimodal approach. Stenting and anastomotic stenosis facilitate the development of hepatolithiasis and increase the risk of its occurrence. In particular, by performing functional hepaticojejunostomy, the development of this complication will be decreased.
Keywords: Anastomosis, bile duct stricture, etiology, hepatolithiasis, treatment
Cite this article as: Dilek ON, Atasever A, Acar N, Karasu Ş, Gür EÖ, Özşay O, et al. Hepatolithiasis: clinical series, review and current management strategy. Turk J Surg 2020; 36 (4): 382-392.
The approval for this study was obtained from İzmir Katip Çelebi University Non-Interventional Clinical Research Ethics Committee (Decision No: 260, Date: 30.05.2019).
Concept - O.N.D., F.H.D.; Design - O.N.D., A.A.; Supervision - O.N.D., E.O.G., F.H.D.; Resource - N.A., A.A., O.Ö.; Materials - N.A., A.A., O.Ö., O.N.D., Ş.K.; Data Collection and/or Processing - O.N.D., Ş.K.; Analysis and Interpretation - O.N.D., Ş.K.; Literature Review - A.A., N.A.; Writing Manuscript - O.N.D., N.A., A.A.; Critical Reviews - O.N.D., F.H.D., A.A.
The authors declare that they have no conflict of interest.
The authors declared that this study has received no financial support.