Multimodality Treatment for Hepatolithiasis

Abstract

Hepatolithiasis is characterized by high treatment-failure and recurrence rates. In the past, surgery played a major role in the management of this disease, but the development of percutaneous transhepatic cholangioscopy and lithotripsy has played an important role in the treatment of this disease. Therefore, we undertook this prospective study to assess the effects of a systematic complementary approach of surgical and therapeutic endoscopic treatments for hepatolithiasis. We evaluated our results for 56 patients with intrahepatic stones treated by a percutaneous transhepatic cholangioscopic approach and by a surgical approach.The rate of complete stone removal was 94.4%(51/54). Twenty-five cases were treated with only a choledochoscopic approach, and 31 cases with a complementary approach(a definitive surgical approach after the choledochoscopic approach). There was no procedure or operative mortality. Because the improvement in the stone clearance rate was evident for the systematic complementary approach, this approach is recommended, when possible.