Laparoscopic treatment for intrahepatic duct stones in the era of laparoscopy: Laparoscopic intrahepatic duct exploration and laparoscopic hepatectomy

OBJECTIVE:: The aim of this study is to analyze our experiences with laparoscopic surgery for treating intrahepatic duct (IHD) stones and to evaluate its role for the management of IHD stone. SUMMARY BACKGROUND DATA:: Until now, laparoscopic surgery for IHD stone has been rarely reported. METHODS:: From October 1998 to June 2007, we performed 76 cases of laparoscopic surgery for treating IHD stones [30 laparoscopic IHD explorations (LIHDE) and 46 laparoscopic hepatectomy (LH)]. The choice between LIHDE and LH was based on the severity of the IHD stricture, the presence of parenchymal atrophy, and the impaction of stones, as determined by the preoperative radiologic images or intraoperative choledochoscopy. Retrospective analysis was done on the clinical outcomes of the 76 patients. RESULTS:: Conversion to open surgery was needed in 6 patients (7.9%). The mean operation time (LIHDE vs. LH) was 278.4 and 344.3 minutes, respectively. The mean postoperative hospital stay was 14.6 and 12.8 days, respectively. Postoperative complications occurred in 28 patients (36.8%), and all of them responded to the conservative management. There was 1 case of postoperative mortality in the LH group because of sepsis. The overall initial success rate of removing the stones by laparoscopic surgery in our intention-to-treat analysis was 78.9% (60 of 76). The reasons for treatment failure included remnant stones (n ≤ 9), conversion to open surgery (n ≤ 6), and postoperative mortality (n ≤ 1). For the 69 patients who had laparoscopic surgery successfully preformed without mortality, the initial success rate of stone clearance was 87.0% (60 of 69) and the final clearance rate after additional choledochoscopic stone removal was 92.8% (64 of 69). CONCLUSIONS:: This study demonstrates that laparoscopic surgery can be an effective option for managing IHD stones and it also suggests the potential role of laparoscopic surgery for treating IHD stones in the era of laparoscopy.