Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
ABSTRACT
Intrahepatic bile duct (IHD) stone is defined as gallstones in any intrahepatic bile duct proximal to the confluence irrespective of the stones in the extrahepatic bile duct. While some patients remain asymptomatic, others may have wide variety of symptoms and morbidities. Among these morbidities, recurrent cholangitis, biliary stricture, liver abscess, liver atrophy, and cholangiocarcinoma are the main reasons for surgery. Surgical resection can satisfy the goal of treatment for IHD stones that is complete removal of intrahepatic stones, stricture, and the risk of cholangiocarcinogenesis. However, in some cases like bilateral IHD stones, surgery alone can’t achieve these goal thus the optimal treatments require multidisciplinary approach including endoscopic and radiologic interventional procedures before and/or after surgery. Nowadays, liver resections are most favored and other procedures such as choledocholithotomy and choledochoenteric anastomosis may be added. The principle of surgery is complete removal of intra/extrahepatic stones and stricture of the duct and adequate drainage of the remaining bile duct. In every case, the presence of cholangiocarcinoma should be suspected. If it is highly suspected, oncologic principle should be applied during the surgery. The patient with IHD stone should be followed up with cautions since recurrent IHD stone and cholangiocarcinoma are not infrequent.
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