2021 Volume 35 Issue 5 Pages 758-765
Hepatolithiasis is characterized by its intractable nature and frequent recurrence. National multi-institutional surveys have been conducted for 40 years or over. The treatment outcomes including residual stones and recurrence are not improved, even treatment techniques are advanced. Non-surgical procedures such as percutaneous transhepatic cholangioscopic lithotripsy (PTCSL), ERC, balloon ERC, and peroral cholangioscopy (POCS) and surgical treatment such as hepatectomy, choledocho-enterostomy, cholecystectomy with stone removal, and papilloplasty were performed for the treatment of hepatolithiasis. Recently, treatment by ERC and Balloon ERC are frequently performed because of increasing of secondary hepatolithiasis and the advance of the endoscopic techniques. For the large stones, combination treatments with ESWL or EHL are performed. Hepatectomy is the most frequently performed as a surgical procedure, and reports of laparoscopic hepatectomy are increasing. The risk of development of cholangiocarcinoma is high, even if complete stone removal is performed. In particular, long-term and strict follow-up is required for patients with risk factors of cholangiocarcinoma.
