Hepatectomy for hepatolithiasis among patients with a history of biliary surgery

Background: Hepatolithiasis is characterized by its intractable nature and frequent recurrence, requiring multiple operative interventions. It is very important to diagnose the complex pathology of hepatolithiasis and choose proper surgical procedures. In this study, outcomes of hepatectomy for hepatolithiasis were evaluated in patients who had previously undergone biliary surgery. Methods: This retrospective study includes 81 consecutive patients who underwent partial hepatectomy between 2008 and 2015 with hepatolithiasis. All patients had undergone biliary surgery one or more times previously. Clinical characteristics, perioperative complications, and long-term outcomes of patients were studied. Results: Among total 81 patients, 56 patients (69.1%) had undergone one previous biliary operation, 21 patients (25.9%) had undergone two, 3 patients (3.7%) had undergone four, and one patient (1.2%) had undergone five. The residual stone rate after hepatectomy was 8.6% (7/81). There was no perioperative mortality. The postoperative complication rate was 12.3% (10/81). Histopathology showed concomitant cholangiocarcinoma in 8 patients (9.9%). The median follow-up period was 45.1 months (range 6-71 months). Recurrent stones developed in 5 of 78 (6.4%) patients who had no residual stones. Six patients died due to recurrence and metastasis of concomitant cholangiocarcinoma during follow-up. Conclusion: Hepatic resection is a safe and effective procedure in the management of hepatolithiasis for patients with a history of biliary surgery. Proper preoperative evaluation is critical to the success of surgery.