OBJECTIVETo evaluate the effect of anatomic hepatectomy performed under vascular exclusion in management of hepatolithiasis.

METHODSFrom May 2002 to March 2005, fifty-three patients with unilateral hepatolithiasis underwent anatomic hepatectomy with exposure and control of inferior vena cava and main trunk of hepatic veins. The hepatic lobes involved by hepatolithiasis were left lateral lobe (S(2), S(3)) in 12 patients, left lobe (S(2), S(3), S(4)) in 26 patients, right posterior lobe (S(6), S(7)) in 8 patients and right lobe (S(5), S(6), S(7), S(8)) in 7 patients. Atrophy of involved hepatic lobes was found in 38 patients. Fourteen patients had experienced more than one operation on biliary tract. Nine patients showed the symptoms of acute cholangitis preoperatively and 4 patients complicated with liver abscess.

RESULTSVascular exclusion was successfully performed on all patients to control the blood inflow and outflow of liver. The anatomically resected hepatic lobes were left lateral lobe (S(2), S(3)) in 12 patients, left lobe (S(2), S(3), S(4)) in 26 patients, right posterior lobe (S(6), S(7)) in 8 patients and right lobe (S(5), S(6), S(7), S(8)) in 7 patients. Except hepatectomy, the additional procedures performed on the patients were choledocholithotomy in 39 cases, choledocho-jejunostomy in 5 cases. The majority of complications were bile leakage in 3 cases, subphrenic infection in 2 cases, hydrothorax in 5 cases and wound infection in 5 cases.

CONCLUSIONSAnatomic hepatectomy under vascular exclusion is effective treatment to eradicate intrahepatic stone foci in case of unilateral hepatolithiasis, and help to reduce intraoperative blood loss and decrease postoperative complications.