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The surgical treatment of isolated left-sided hepatolithiasis: a 22-year experience.

BACKGROUND
Various therapeutic methods are used in isolated left hepatolithiasis (ILH), and long-term results are not as satisfactory as they should be.


METHODS
A retrospective analysis of 128 patients with ILH who were treated in our center over the last 22 years was undertaken to address patient age, gender, preoperative evaluation, operative findings, treatment modalities, and postoperative courses.


RESULTS
Sixty of the 128 patients were male and 68 were female, with a mean age of 42 years (range, 16-72 years). Among these patients, most (81%) had stones in both left external hepatic duct (LEHD) and left medial hepatic duct; in contrast 13 patients (10%) had stones only in the LEHD, and 7 patients (6%) had stones only in the left hepatic duct. Concomitant strictures were present in the left hepatic duct, left medial hepatic duct, and LEHD in 60%, 76%, and 82%, respectively, most of which were severe. When compared with left lateral segmentectomy, left hepatic lobectomy had a lower rate of residual stones (4% vs 22%; P < .01). Residual/recurrent stones and ductal strictures were the 2 most common causes that affected the long-term results. Before June 1996, left lateral segmentectomy was performed more frequently than left hepatic lobectomy (59% vs 12%; P < .01); after June 1996, left hepatic lobectomy was performed more frequently (77% vs 13%; P < .01). Although there were no differences in length of operation, intraoperative bleeding, and postoperative complications, residual stones were more common after left lateral segmentectomy.


CONCLUSIONS
Left hepatic lobectomy appears to be the most effective treatment for selected patients with ILH, if other operative procedures cannot remove all the related lesions, which include stones, dilation, stricture, or potential cholangiocarcinoma.