Hepatolithiasis has high rate in biliary lithiasis. The diagnosis and treatment are still controversial as the problem of residual and recurrent stones. Objective: Evaluate the efficacy of multimodality management of hepatolithiasis. Material and method: prospective study from 6/2009 to 6/2011. With 100 patients enrolled in this study. Results: Male/female: 37/63, average age: 49.75. Cholangitis is the most common clinical manifestation, diagnosis made by US, and MRCP is needed in complicated cases. The study have 34 hepatolithiasis in left liver, 16 cases in right liver, and 50 cases in both sides. We performed 100 operations with Choledochotomy in 49 pts, choledochotomy with liver resection in 28 pts, 2 hepatectomies, Choledochotomy and hepaticojejunostomies in 21 pts. Cholangioscopy performed in 79 cases and 74 cases have Kehr drainage. Morbidity rate is 21 percent and one death due to liver failure 3 months .after operation. In 64 cases, the authors performed cholangioscopy by T tube tract for residual stones. The clearance rate is 86 percent. Hepatectomies were done in 30 cases with right hepatectomy 2 cases, left hepatectomy 2 cases and left lateral segmentectomy in 28 cases, Hepatectomy group has a highest stone clearance rate 96.7 percent. The high residual stone rate in patients with bile duct stricture. The recurrent stone could be withdrawn by hepatico cutanous - jejunostomy stoma. Conclusion: Hepatolithiasis is diagnosed by US and MRCP reserved for complicated case. Multimodality treatments with choledochotomy, hepatectomy, cholangioscopy intra and post operative could increase the stone clearance rate. Hepatectomy is the most effective method.
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