A Retro-Prospective Study of Histopathological Findings in Isolated Left Sided Hepatic Resections in Cases of Isolated Left Sided Hepatolithiasis
Journal Title: International Journal of Medical Research Professionals - Year 2017, Vol 3, Issue 5
Abstract
Objective: To study detailed preoperative anatomy of left hepatobiliary system in cases of isolated left sided hapatolithiasis, appropriate surgical management and histopathology findings in isolated left hepatic resection specimens. Material and Methods: This retro-prospective study was conducted at Sher-i-Kashmir Institute of Medical Science, Srinagar between May 2003 and December 2011. A total number of 80 cases were included in the study. All cases of isolated left sided hepatolithiasis were preoperatively evaluated for detailed anatomical assessment of left hepatobiliary system. Based on anatomical assessment appropriate surgical management; left hemi-hepatectomy or left lateral sectionectomy was done. Histopathological examination of isolated left hepatic resection specimen in left hepatolithiasis was carried carried out for grading of fibrosis/glandular changes/inflammation/other changes of chronic proliferative cholangitis and detection of any malignant changes. Results: The results of present study show that Left lateral section of the liver (segment 2 & 3) is most commonly involved in isolated left hepatolithiasis (70.0%) and Type 1 LHD Anatomy is the principal variant seen in 72 cases (90%). Total left hepatic resections carried out were 80. Left lateral sectionectomy was done in 56 subjects, left hemi hepatectomy was done in 23 patients and left hemihepatectomy with caudate lobe resection was done in 1 subject. In the present study detailed histopathological examination revealed; Severe portal fibrosis (43.7%) is the most common type of portal fibrosis, Severe periportal fibrosis (42.5%) is the most common type of periportal fibrosis, Moderate portal inflammation (73.75%) is the most common type of portal inflammation seen, Moderate periportal inflammation seen in 70.0% of patients is the most common type of periportal inflammation. Moderate ductal proliferation seen in 35.0% is the most common type of ductal proliferation seen; Cholestasis is seen in 83.75% and hepatic necrosis in 46.25%. Cholangiocarcinoma is seen in 2 cases (2.5%). Bacterial culture of the cases showed Escherchia coli in 41.25%cases, klebsiella in 21.25%, proteus in 12.5%, pseudomonas aerugenosa in 8.7% and multiple organisms in 16.2%of the cases. Conclusion: Isolated left sided hepatic resection is an appropriate management for isolated left sided hepatolithiasis as it removes all intrahepatic stones along with the pathological bile ducts thus eliminating the chances of recurrent intrahepatic stones and the most unfavorable complication of disease i.e intra-hepatic Cholangiocarcinoma (IHCC).
Authors and Affiliations
Mushtaq Ahmed, Pradeep Goyal, Chunauti Pandita, O. J. Shah, Parveen Shah
Keywords
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- EP ID EP547577
- DOI 10.21276/ijmrp.2017.3.5.049
- Views 97
- Downloads 0
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