Diagnostics and surgical tactics for hepatolithiasis

Purpose. Improving the diagnosis and surgical treatment of hepatolithiasis. Material and methods. The results of complex diagnostics and treatment of 34 patients with hepatolithiasis over the last 10 years have been analyzed. In 31 (91.2%) cases, there was a secondary «western» type of hepatolithiasis, in 3 (8.8%) cases - a primary «eastern» type of the disease. The etiological causes of secondary hepatolithiasis in 18 (52.9%) cases were high strictures of the bile ducts and formed hepaticojejunoanastomoses. In 5 cases choledocholithiasis was diagnosed with spread to the intrahepatic bile ducts, in 4 (11.8%) cases hepatolithiasis developed on the basis of cholestasis and strictures of ectazed intrahepatic bile ducts in Carroli’s disease (n = 2) and opistochorous stricture of segmental bile ducts. In 4 more cases it was not possible to establish the etiological factors of hepatolithiasis. Results. For the correction of hepatolithiasis in their observations, open traditional surgical interventions were applicable in 26 cases with performing resection and reconstructive-restorative surgical interventions of various nature and volume. In the postoperative period, 13 (38.2%) septic complications with 1 (2.9%) death were observed. Minimally invasive interventions were performed in 8 cases with secondary hepatolithiasis using antegrade and retrograde methods, both restoring the outflow of bile in the area of posttraumatic, postischemic, inflammatory biliary stricture, hepati-cojejunostomy stricture, and destroying calculi (lithoextraction). In 2 cases, there were so-called «minor» complications in the form of migration of cholangiostomy drainage. There were no deaths. Conclusion. Thus, in the treatment of hepatolithiasis, a personalized approach is the most effective, it allows in each case to choose the most pathogenetically justified method of treatment.