Results of surgical treatment for intrahepatic gallstones.

On the basis of the results of our surgical treatment of 85 patients with intrahepatic gallstones, effective methods for surgical treatment of this disease were discussed. The operative mortality rate for these patients was 10.6 percent. Most of the fatal cases had long duration of symptoms and showed evidence of hepatic fibrosis or biliary cirrhosis at the time of operation. The results emphasize that, in cases of long duration of symptoms, it is generally necessary to examine thoroughly prior to operation the presence or absence of liver parenchymal injury and to pay deliberate attention to minimizing operative intervention. Especially, in hepatic lobectomy, its indication must be scrutinized carefully assessing the condition of the patient. In our follow-up study, 80 percent of the patients were found living with almost no complaints, 5 patients having occasional bouts of cholangitic attack included 3 patients who had left the hospital having residual gallstones. Including these 3 patients, 7 of 9 patients with residual gallstones showed severe hepatic dysfunction. In general, indications of our operations for different types of patients with intrahepatic gallstones have been evaluated as satisfactory. For the favorable management of intrahepatic gallstones, two points are specially emphasized: thorough scrutinization of liver parenchymal disorder prior to operation, and long-term observation for care of survivors with residual gallstones.