I think you will find that liver stones
(also called intrahepatic stones) are something rather different form the Gallstones
you think you may have captured.
Refer to http://www.clib.psu.ac.th/acad_44/sprinya1.htm for example, to learn a bit about the problem and its seriousness.
Transhepatic exploration for left intrahepatic stones
Prinya Soontrapornchai, Asst. Prof., Dept. of Surgery, Fac. of Medicine, PSU.
E-mail : email@example.com
Presented : The 17th Annual Academic Meeting, Faculty of Medicine, PSU., Hat Yai, Songkhla, 15-17 August 2001
Key words : transhepatic exploration, left intrahepatic stones, intrahepatic stones
Introduction: Intrahepatic stones are difficult to remove due to its associated proximal struc-ture and frequent recurrence even after complete stone removal. Two main treatments are suggested. Liver resection is indicated for left-sided stones when the patient has atrophic segment or lobe of the affected liver. Percutaneous transhepatic cholangioscopy is indicated for bilateral or recurrent stone but has some failure and stone recurrence rate.
Objective: The aim of the study is to report personal experience in the management of left intrahepatic stones by transhepatic approach.
Methods: Three patients underwent exploratory laparotomy for intrahepatic stones between June 1998 and March 2001. All patients had been failed to treat by endoscopic stone removal (ERCP). Two of them had bilateral hepatic stones. At operation, the left hepatic duct, either in segment II or III, was located by palpation of the stones or intraoperative ultrasound then the duct was opened longitudinally via hepatotomy. Stones were removed by stone forceps or choledochoscope. Finally, the Roux limb of jejunum was brought to anastomose with the widely opened duct.
Results: All patients were recovered uneventfully. Wound infection occurred in one case. The follow-up period was between 2 months and 3 years. Two of them were asymptomatic and no stone recurrence during follow-up. One patient developed recurrent Cholangitis
which sclerosing Cholangitis
was suspected by cholangiogram and treated by stenting.
Conclusion: Transhepatic exploration offers some advantages: 1) to avoid the hepatectomy in the case of liver hypertrophy which its parenchyma is preserved, 2) less morbidity and mortality than liver resection, 3) easier stone removal than percutaneous method, 4) the presence of hepatico-jejunostomy providing good bile drainage to prevent stone recurrence, 5) access route via ERCP is still preserved.