International Surgery Journal | March 2021 | Vol 8 | Issue 3 Page 1016 International Surgery Journal Kokoroskos N et al. Int Surg J. 2021 Mar;8(3):1016-1019 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Surgical management of hepatolithiasis: an institutional experience of a rare disease Nikolaos Kokoroskos*, Konstantinos Alifieris, Loukas Agorgianitis, Sotirios Zouglos, Spyridon Delis INTRODUCTION Hepatolithiasis, although prevalent in East Asia, remains as an uncommon entity in most western countries. 1 However, immigration waves from countries with high prevalence are expected to change the epidemiological status of the disease in the western world. 2,3 Genetic, dietary and environmental factors are considered to be contributory to the disease. 3,4 However, the etiology of hepatolithiasis has yet to be fully determined. The goal of hepatolithiasis treatment is to resolve ongoing infections, prevent recurrent cholangitis and subsequent hepatic fibrosis, avoid multiple instrumentations and minimize the potential of progression to cholangiocarcinoma. 5 Despite that conservative management options have been well described and established in the literature; surgery remains the standard of care for the definitive treatment of the disease. Particularly, sectional hepatectomy is considered as the best approach for the treatment of calculi of the intrahepatic ducts, since it removes stones, along with the strictured intrahepatic duct, resects the atrophic portion of the liver and, additionally, eliminates the potential of cholangiocarcinoma development. 6,7 In current study, we sought to present the recent experience regarding the surgical management of recurrent, symptomatic left hepatolithiasis in the background of a narrative literature review. ABSTRACT Hepatolithiasis remains as a rare condition in the majority of western world countries. Although genetic, dietary and environmental factors have been associated with the disease, the exact etiology of this entity remains elusive. Several approaches; surgical and non-invasive have been well described. However, surgery remains the standard of care for definitive treatment of the disease. We sought to present the recent experience of our clinic regarding the surgical management of hepatolithiasis in the backgound of a narrative literature review. All adult patients with hepatolithiasis admitted to our center during the period 2018 to 2020 were included in the study. Patients’ demographics, comorbidities and preoperative characteristics were collected by chart review. All patients underwent open left lateral hepatectomy. Three cases with hepatolithiasis were identified. All of them were male and had been suffering from recurrent pyogenic cholangitis. All patients remained asymptomatic and disease-free through the entire follow-up, except one case that was complicated with bile leakage during the immediate postoperative period. Hepatolithiasis is currently a rare condition in the western world. Surgery is safe and effective treatment approach for refractory cases and, provided that it is performed by experts in hepatobiliary surgery, it remains imperative for the definitive treatment of the disease. Keywords: Hepatolithiasis, Surgery, Left lateral hepatectomy Department of Surgery, Konstantopouleio General Hospital, Athens, Greece Received: 17 October 2020 Revised: 21 January 2021 Accepted: 05 February 2021 *Correspondence: Dr. Nikolaos Kokoroskos, E-mail: nickkokordoc@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20210939