IJSR - International Journal of Scientific Research

Dr.A.Rajkumar; Dr.M.Thiruvarul; Prof.S.Jeswanth; Prof.C.Sugumar; Dr.R.Prabhakar; Dr.P.Senthilkumar; Dr.R.Kamalakannan; Dr.J.Saravanan

Volume : VIII, Issue : VIII, August - 2019

Outcomes of CBD Exploration with Stone Extraction and Liver Resection in management of Hepatolithiasis –In our centre experience

Dr. A. Rajkumar, Dr. M. Thiruvarul, Prof. S. Jeswanth, Prof. C. Sugumar, Dr. R. Prabhakar, Dr. P. Senthilkumar, Dr. R. Kamalakannan, Dr. J. Saravanan

Abstract :

Aim : To describe the outcomes of CBD Exploration with Stone Extraction and Liver Transplant in the management of hepatolithiasis and to assess the long term outcome in each surgical method . Design : Retrospective study Methods : Clinical records of 34 patients diagnosed as hepatolithiasis underwent CBD Exploration with Stone Extraction and Liver Transplant were reviewed .Clinical data, operative notes ,post operative events and follow up records from Jan2009 to Dec 2018 were retrieved and analysed . Outcomes : Recurrence of intrahepatic stone and cholangitis Results : 34 patients were surgically managed for hepatolithiasis . 19 patients (55 %) underwent liver resection(Left lateral segmentectomy –6,Left hepatectomy –8,Right hepatectomy –4,Mesohepatectomy –1.) . Among the patients who underwent liver resection, 9 patients (47 % ) was previously managed by CBD exploration with stone extraction for hepatolithiasis . The remaining 15 patients were managed by CBD exploration , intraoperative cholangioscopy , stone extraction with either choledochoduodenostomy or hepaticojejunostomy + / – access loop . Of these 15 patients , 2 patients developed biliary cirrhosis and underwent liver transplant , 2 patients died due to recurrent cholangitis and the remaining 11 patients are under follow up and not develop any recurrent stones /cholangitis in the 5 year follow up period. Conclusion : The long– term outcomes of Liver resection for Hepatolithiasis in selected patients had excellent outcome than intrahepatic stone removal primarily by surgical CBD Exploration /Intraoperative Choledochoscopy . Stone extraction group Subsequently develop recurrent intrahepatic stone and recurrent cholangitis and invariably need Liver resection or liver transplant .Liver resection also has the advantage of removing the diseased liver and reducing the risk of intrahepatic cholangiocarcinoma in the future