Abstract
In four cases of hepatolithiasis, we performed cholangiotomy, lithotomy, and bile drainage attachment (hepaticojejunostomy and choledochojejunostomy) from both proximal (porta hepatis) and distal sites by pincer operation and obtained excellent results.
A rapid increase in frequency of hepatectomy was found in recent cases out of 56 hepatolithiasis operations in our hospital. The reason was that the diagnosis of the disease became possible at younger ages prior to the onset of the disease by a progress of diagnostic instruments. In some cases however, the hepatectomy should be avoided because of stones in both lobes and poor reserve function of the liver. This implys difficulty of surgical treatments. Cholangiography, a main traditional intraoperative examination, dose not give informations of the duct distal to the occlusion site or sufficient image and cholangioscopy misses local sites beyond expected frequency. On the other hand, ultrasonography is a useful assistant tool for a complete removal of stones and an improvement of cholestasis and thus should become the base of the surgical treatment for hepatolithiasis.
