Kailash Kumar Thakuria1 , Ridipta Sekhar Das2 , Partha Pratim Barua3
BACKGROUND Hepatolithiasis or intrahepatic stones irrespective of gall bladder stones or common bile duct stones are common in East Asian countries but rare in Western countries. Although Gall bladder stones are common in India, there is scarcity of literatures reporting hepatolithiasis from the Indian subcontinent. This study aimed to evaluate the clinical result of our first-hand experience of hepatectomies along with other standard surgical options for this low prevalence disease in a North East Indian institute catering to a rural population. METHODS 11 patients with diagnosis of hepatolithiasis operated from the period June, 2014 to June 2019 were included in this study. Pre-operative radiological and biochemical, operative & postoperative variables were assessed. Patients were followed in a planned program. RESULTS Hepatic involvement were noted as Left lobe in 7 (64 %) cases, only right lobe in one case (9 %) and bilateral in three cases (27 %). Five cases (45.5 %) were associated with extrahepatic biliary pathology; concomitant intrahepatic and extrahepatic stones were seen in four cases (36 %). Anatomical left hepatectomies (3), left lateral sectionectomies (2) choledochotomy and T-tube drainage (6 primarily or one additional) were carried out. Functional outcomes were satisfactory in all patients. Postoperative morbidity was mostly due to wound infection and there was no mortality. CONCLUSIONS Preoperative optimization of patients, relative absence of risk factors and knowledge of biliary anatomy planned with modern imaging tools makes hepatectomy a safe definitive surgical option for localised hepatolithiasis. Hepaticojejunostomy may be contemplated selectively for bilateral hepatolithiasis. Long term follow up is necessary as recurrence is associated with this disease.
