Laparoscopic versus open left hemihepatectomy for hepatolithiasis

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Gastroenterology

Background:

• Hepatolithiasis, or intrahepatic bile duct stones, necessitates surgical intervention.
• Partial hepatectomy is the definitive treatment, with laparoscopic approaches presenting unique challenges.
• Left intrahepatic duct stones require specific surgical considerations.

Purpose of the Study:

• To compare the safety and outcomes of laparoscopic left hemihepatectomy (LLH) versus open left hemihepatectomy (OLH).
• To evaluate perioperative and long-term results for treating left intrahepatic duct stones.

Main Methods:

• Retrospective review of 97 consecutive patients with left intrahepatic duct stones.
• Comparison of outcomes between LLH (n=46) and OLH (n=51) groups.
• Evaluation of clinical outcomes and stone clearance rates.

Main Results:

• No significant difference in surgical procedure times between LLH and OLH.
• LLH showed a trend towards less intraoperative blood loss, though not statistically significant.
• LLH resulted in a significantly shorter postoperative hospital stay (11 days vs. 12 days) and comparable stone clearance rates (93.5% vs. 94.1%).

Conclusions:

• LLH is a safe and effective procedure for left-sided hepatolithiasis, with low morbidity and high stone clearance.
• LLH offers the advantage of a shorter hospital stay compared to OLH.
• Careful patient selection based on lesion extent and distribution is crucial for successful LLH.