Introduction : [Background] Recurrent cholangitis and sepsis are common complications after surgical treatment for hepatolithiasis as total clearance is not always possible. The present study is designed to see the effect of our treatment for hepatolithiasis on stone clearance and post operative complications.

Methods : [Methods] We have treated 60 patients with hepatolithiasis surgically between 2010 to 2016 in the Department of Surgery, BSMMU, Dhaka. Various operative procedures were applied on the basis of location of stones. Choledocoscopic examination was performed during surgery for checking and cleaning of intrahepatic duct. Regular follow up was given and outcome was assessed.

Results : [Results] Stones were located in left duct (56.6%), right duct (10%) and both duct (33.4%). Segmentectomy or lobectomy, extended choledocholithotomy- hepatolithotomy and common bile duct (CBD) excision-hepatolithotomy were performed in 17, 28 and 15 patients respectively. Stones could be removed completely in all patients who underwent lobectomy or segmentectomy. In contrast stone clearance was possible only in 57.2% and 55.5% who underwent extended choledocholithotomy-hepatolithotomy and excision of CBD-hepatolithotomy respectively. There was no mortality but morbidity occurred in 18 patients. Patients who underwent lobectomy or segmentectomy did not develop cholangitis or sepsis in 1 to 3 years follow up. In contrast cholangitis and sepsis occurred who underwent extended choledocholithotomy- hepatolithotomy or CBD excision-hepatolithotomy in 70.8% and 50% respectively (p<0.05).

Conclusions : [Conclusion] Lobectomy or segmentectomy is the best option for hepatolithiasis if the stones are limited to a lobe or segment. Excision of CBD-hepatolithotomy with hepaticojejunostomy is better than extended choledocholithotomy- hepatolithotomy for bilateral hepatolithiasis.