Parasites and Biliary stones

Hepatolithiasis ٩٢
Hepatic resection for localized disease:
Hepatic resection is indicated for localized intrahepatic stones or
biliary strictures when the affected liver segment is already atrophic or
when an abscess is present in the surrounding parenchyma (Sato et al.,
1980 and Choi and Wong, 1986). With a localized intrahepatic
cholangiocarcinoma, hepatic resection offers a chance for cure (Chen et
al., 1989). When intrahepatic stones are restricted to the left side of the
liver, lobar resection or left lateral segmentectomy ensures removal of the
source of recurrent infection. Hepatic lobectomy, however, is rarely
performed when stones are located in the right lobe, because of a high
complication rate (Fan et al., 1993).
Prevention of stone and stricture recurrence:
Even in the absence of a significant biliary stricture, improvement of
biliary drainage helps to minimize the chance of stone recurrence.
Permanent biliary drainage ranges from sphincterotomy and surgical
sphincteroplasty to surgical bilioenteric anastomosis at different levels of
the biliary system, including choledochoduodenostomy, and
hepaticojejunostomy constructed at the hepatic confluence, the left
hepatic duct or the left lateral inferior duct. Creation of a
hepaticocutaneous jejunostomy allows ready access to the bile ducts. The
surgical anastomosis is made at the bifurcation, one end of the jejunal
loop being brought to the skin surface via a straight and short route. The
access enables repeated sessions of both stricture dilatation and stone
extraction. After the completion of therapy, the stoma can be closed and
buried subcutaneously (Gott et al., 1996). The stoma provides the option
for accessing the conduit percutaneously or re-opening the stoma in case
of stone recurrence (Fan et al., 1993).