Outcomes of liver resection for intrahepatic stones: a comparative study of unilateral versus bilateral disease.

Objective: This study aimed to compare the outcomes of liver resection for unilateral and bilateral intrahepatic stones.

Background: Hepatectomy is effective in treating intrahepatic stones accompanied by biliary stricture or segmental atrophy. The outcomes between unilateral and bilateral intrahepatic stones may be varied because of different complexity of these 2 subtypes of disease.

Methods: From January 1992 to December 2008, 718 consecutive patients with intrahepatic stones underwent elective hepatectomy in our center were reviewed. The outcomes of patients with unilateral stones (n = 461) and bilateral stones (n = 257) were compared. The consistency between extent of liver resection (ELR) and stone-affected segments (SAS) was classified into 2 categories: ELR = SAS and ELR < SAS. The risk factors of stone recurrence were identified by Cox regression model.

Results: The immediate stone clearance rates of the unilateral group and the bilateral group were 93.5% and 71.1%, respectively. Postoperative cholangioscopic lithotomy raised the clearance rates to 99.3% and 90.2%, respectively. The surgical morbidities were 20.4% and 38.5%, respectively. The hospital mortality rates of both groups were 0.4%. The 5-year stone recurrence rates were 6.2% and 16.7%, respectively. Cox regression analysis showed that stone distribution (hazard ratio [HR] = 2.462, P = 0.007) and consistency between ELR and SAS (HR = 3.100, P = 0.002) were independent prognostic factors for stone recurrence.

Conclusions: Generally, patients with unilateral stones have better outcomes than those with bilateral stones after hepatectomy associated with cholangioscopic lithotomy. But for the patients with ELR equals to SAS, the stone recurrence rates of unilateral and bilateral stones are low and comparable.