Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis

Background. Hepatolithiasis is a common disease in East Asia. Operative and nonoperative procedures for the management of hepatolithiasis have been discussed, but long term follow-up results of such treatments are only reported rarely. We evaluated the long-term results of of operative and nonoperative treatments and examined risk factors for the recurrence of stones or cholangitis. Methods. We conducted a retrospective study of case records of patients with hepalolithiasis who underwent treatment by operative therapy or nonoperative percutaneous transhepatic cholangioscopy (PTCS), or peroral cholangioscopy. Of 311 patients with hepatolithiasis, 236 underwent follow-up after operative (n = 90), PTCS (n = 97), or peroral cholangioscopy (n = 49) treatment. Results. Complete stone clearance was achieved in 83.3% of hepatectomy, 63.9% of PTCSL, and 57.1% of peroral cholangioscopy patients. After a median follow-up period of 8.0 years (up to 37 years), we observed stone recurrence in 30.9% (73/236) of patients, secondary biliary cirrhosis in 8.5% (191224), late development of cholangiocarcinoma in 4.8% (11/227), and a mortality rate of 8.1% (19/236). Stricture, stones in both lobes, and nonoperative treatments were significant risk factors for incomplete stone clearance on multivariate analysis. In addition, recurrent stones and/or cholangitis were associated with nonoperative therapy (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.10-3.65), biliary cirrhosis (HR, 2.22; 95 % CI, 1.24-3.98), residual stones (HA 1.98; 95 % CI, 1.24-3.17), and stricture (HR, 1.86; 95 % CI, 1.01-3.43). Conclusion. In this long-term follow-up study, nonoperative therapy, biliary cirrhosis, residual stones, and biliary stricture were associated with recurrent stones and/or cholangitis after treatment. (Surgery 2009;146;843-53.)