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Hepatolithiasis is characterized by its intractable nature and frequent recurrence, requiring multiple operative interventions. It is well known that longstanding intrahepatic stones lead to biliary stricture, biliary cirrhosis, and intrahepatic cholangiocarcinoma. The primary goals of treatment are to eliminate attacks of cholangitis and remove the entire stones for the prevention of biliary cirrhosis. Surgery has a primary role in isolated left or right-sided hepatolithiasis. Percutaneous cholangioscopy is an alternative when surgical resection of the affected lobe is difficult (e.g. hepatolithiasis of both lobes). Techniques for lithotripsy, including shockwave and laser, can be applied in endoscopic sessions, offering a better chance of clearing the stones. However hepatolithiasis tends to recur after percutaneous cholangioscopy, multiple sessions of the endoscopic approach or additional surgical approach are often required. (Korean J Med 75:642-645, 2008) |
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