Segment-Targeted Resection Strategy for Bilateral Hepatolithiasis: A Retrospective Study in Bangladesh

Background: Bilateral hepatolithiasis is difficult to treat because stones may be distributed across multiple intrahepatic ducts and may persist despite duct exploration and biliary drainage.We evaluated a segmenttargeted surgical strategy designed to remove the hepatic segments most frequently involved in our patients with bilateral hepatolithiasis.Materials and methods: We retrospectively reviewed 120 patients who underwent surgery for hepatolithiasis at Bangladesh Medical University, Dhaka, between 2010 and 2024.Forty-six patients had bilateral hepatolithiasis on preoperative magnetic resonance cholangiopancreatography, of whom 40 with available follow-up data were included.Patients treated from 2010 to 2020 formed Group I (n = 26) and underwent conventional surgical management consisting of extended choledocholithotomy and/or extrahepatic bile duct excision with biliary reconstruction.Patients treated from 2021 to 2024 formed Group II (n = 14) and underwent combined resection of segments 2, 3, 5, and 6, extrahepatic bile duct excision, irrigation of the remaining intrahepatic ducts, and Roux-en-Y hepaticojejunostomy.Complete stone clearance, residual stones, recurrent postoperative cholangitis, hospital readmission for cholangitis, and postoperative endoscopic retrograde cholangiopancreatography (ERCP) were compared.Results: Complete stone clearance was documented in 12 of 26 patients (46.2%) in Group I and 14 of 14 patients (100%) in Group II (Fisher's exact test, p < 0.001).Residual stones were identified in 14 Group I patients (53.8%) and none in Group II.Recurrent postoperative cholangitis requiring hospital readmission occurred in 14 Group I patients (53.8%) and none in Group II.Six Group I patients (23.1%) underwent postoperative ERCP for stone or stent management; no Group II patient required this intervention.Followup duration was up to 14 years in Group I and ranged from four months to four years in Group II.Conclusions: In this single-center retrospective cohort, segment-targeted resection combined with extrahepatic bile duct excision and Roux-en-Y hepaticojejunostomy was associated with complete stone clearance and no documented recurrent postoperative cholangitis during follow-up.These findings support prospective evaluation of the technique in larger cohorts with standardized follow-up.