Current management and long-term prognosis of hepatolithiasis.

OBJECTIVE: To assess the surgical and endoscopic treatment results and long-term prognosis of hepatolithiasis.

DESIGN: Retrospective case series.

SETTING: University hospital.

PATIENTS: Eighty-five consecutive patients with hepatolithiasis treated between 1980 and 1993.

MAIN OUTCOME MEASURES: Location of calculi, associated diseases, treatment procedures, and long-term prognosis were analyzed.

RESULTS: Thirty-eight percent of the 85 patients had stones only in intrahepatic ducts, while others had intrahepatic and extrahepatic calculi. Seventy-two percent of the patients had repeated biliary surgery, and 14% were associated with liver cirrhosis. After surgery combined with cholangioscopy and electrohydraulic lithotripsy, the complete stone clearance rate was 71%. The treatment-related mortality rate was 3.8%; the stone recurrence rate after complete stone removal was 11%. However, it was notable that 17 patients (20%) died of related diseases during a mean follow-up of 6 years. The reasons for death were liver failure, bleeding from esophageal varices, hepatocellular carcinoma, and cholangiocarcinoma.

CONCLUSION: Improvement of stone clearance rate is evident by a systematic approach. Complete relief from calculi, bile stasis, and cholangitis at an early stage of the disease is mandatory to prevent progressive liver damage, because repeated recurrence of intrahepatic calculi and cholangitis ultimately lead to irreversible liver damage and hepatobiliary carcinomas with a high mortality.