Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2169
Peer-review started: June 24, 2014
First decision: August 6, 2014
Revised: September 8, 2014
Accepted: November 18, 2014
Article in press: November 19, 2014
Published online: February 21, 2015
Processing time: 233 Days and 0 Hours
AIM: To investigate clinical features, treatment strategies and outcomes of patients with hepatolithiasis (HL) undergoing surgical treatment, using a new clinical classification.
METHODS: Sixty-eight HL patients were hospitalized and treated surgically from August 2011 to December 2012 and they were classified into four HL types according to pathological evolution of the disease. These four HL types included type I primary type (defined as no previous biliary tract surgery), type II inflammatory type (with previous biliary tract surgery and cholangitis), type III mass-forming type (HL complicated by hepatic mass-forming lesion), and type IV terminal type (with secondary biliary cirrhosis and resultant portal hypertension). The perioperative data including general information, imaging data, postoperative complications, and immediate and final stone clearance rate were obtained and analyzed.
RESULTS: In all 68 patients, the proportion of HL type I-IV was 50% (34/68), 36.8% (25/68), 10.3% (7/68) and 2.8% (2/68), respectively. Abdominal pain was the main clinical manifestation in type I (88.2%), fever was predominant in type II (52.0%), the malignancy rate in type III was high (71.4%), and portal hypertension and spleen enlargement were common in type IV (2/2, 100.0%). Liver resection rate for types I-III was 79.4%, 72.0% and 71.4%, respectively. The overall incidence of postoperative complications was 23.5% (16/68). There were no perioperative deaths. The average length of hospital stay was 12.7 ± 7.3 d. Immediate and final stone clearance rate was 73.5% (50/68) and 89.7% (61/68), respectively. Fifty-nine of 68 patients (86.8%) were followed- up for > 1 year after surgery, and 96.6% of these patients (57/59) had a good quality of life according to a criterion recommended for postoperative evaluation of quality of life.
CONCLUSION: The pathological evolution-based clinical classification of HL has a role in optimizing treatment strategy, and patients can benefit from this classification when it is used properly.
Core tip: Hepatolithiasis (HL) is a complicated disease to treat and has few conveniently used clinical classifications. In this study, a new clinical classification for HL based on pathological evolution was introduced, which included HL types I-IV based on with (type II) or without (type I) previous biliary tract surgery, with mass-forming lesion (type III) or secondary biliary cirrhosis with portal hypertension (type IV). It is safely and conveniently used in our hospitals and patients can benefit from this classification when it is used properly.