La calcolosi intraepatica

A review of one-hundred cases of intra-hepatic lithiasis, observed between 1967 and 1996 by the same surgical team, was reported in this paper. There were 61 cases of migrated stones and 39 cases of primary duct stones (31 above a stenosis and 8 associated to biliary malformations). 83 patients underwent surgery: in 31 cases, gallstones were removed through the CBD, while a bilio-enteric anastomosis was required in 47 cases; 5 patients underwent a left liver resection. Finally, 17 patients were treated by non-surgical means (endoscopic or radiologic). In a first period, diagnosis was made intraoperatively by cholangiography or choledochoscopy and surgery was the only therapeutic option. After 1980, diagnostic procedure included ultrasonography, CT and direct cholangiography (endoscopic or percutaneous). Consequently to the development of endoscopic (ERCP) or percutaneous (PTC) approaches to remove intrahepatic gallstones, many patients were treated by these non-surgical means, which, in some cases, were associated with extracorporeal lithotripsy. Abnormalities of intrahepatic biliary tree represented an elective indication for liver resection in the last years. The clinical results improved progressively: mortality was 8.3% in the first ten years (67-76), 7.1% in the second decade (77-86) and there was no mortality in the last ten years. In the first decade, intrahepatic biliary tree was completely cleared from gallstones in the 70.8% of cases, in the second decade in the 80.9% of cases and, in the last ten years, in the 97% of cases.