Controlled low central venous pressure in laparoscopic left hemihepatectomy for left hepatolithiasis with prior upper...

This study aimed to evaluate the safety and effectiveness of controlled low central venous pressure (CLCVP) during middle hepatic vein (MHV)-guided laparoscopic anatomical left hemihepatectomy for patients with intrahepatic bile duct stones and a prior history of upper abdominal surgery. A retrospective analysis was conducted on the clinical data of patients who had undergone MHV-guided laparoscopic anatomical left hemihepatectomy for hepatolithiasis with a prior history of upper abdominal surgery. The patients were treated at the Second Affiliated Hospital of Nanchang University and the Second Hospital of Longyan between January 2018 and January 2024. The patients were divided into CLCVP group (0 ≤ CVP ≤ 5 cmH2O) and normal CVP (NCLCVP) group (5 < CVP ≤ 10 cmH2O). The preoperative, intraoperative and postoperative clinical data of the 2 groups were analyzed and compared. This study included 100 patients, 45 in the CLCVP group and 55 in the NCLCVP group. The 2 groups showed no significant disparities in baseline data. Conversion to open surgery occurred in 7 (7%), while the remaining procedures were successfully performed laparoscopically. Compared with the NCLCVP group, the CLCVP group had shorter operation time (303.00 ± 40.15 minutes vs 328.18 ± 51.43 minutes, P = .007) and less blood loss (185.56 ± 71.21 mL vs 260.00 ± 122.63 mL, P < .001). There was no significant difference in other observation indexes between the 2 groups. When preoperative liver function is evaluated and patients' perfusion parameters are closely monitored during the procedure, CLCVP can be safely and effectively applied in MHV-guided laparoscopic anatomical left hemihepatectomy for intrahepatic bile duct stones patients with previous upper abdominal surgery. This technique contributes to reduced blood loss and a shorter operative duration.