Application of laparoscopic hepatectomy for the treatment of hepatolithiasis

Abstract

Objective To summarize clinical experience of laparoscopic hepatectomy in the treatment of hepatolithiasis. Methods Clinical data of 78 patients with hepatolithiasis undergoing laparoscopic hepatectomy in the Second Affiliated Hospital of Nanchang University from March 2016 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 29 cases were male and 49 female, aged 20-80 years with a median age of 54 years. All patients underwent laparoscopic hepatectomy. Choledocholithotomy and choledochoscopic exploration were performed in patients complicated with choledocholithiasis or hepatolithiasis of the contralateral side. T-tubes were inserted as appropriate during the operation. Results Of the 78 patients undergoing laparoscopic hepatectomy, 5 cases were converted to laparotomy, 38 cases underwent left hepatectomy, 33 left lateral lobectomy, 2 right hepatectomy, 5 resection of segment Ⅵ, 27 choledocholithotomy and 16 cases received T-tube placement. The mean operation time was (257±63) min. Intraoperative blood loss was (280±72) ml. 6 cases received intraoperative blood transfusion. Postoperative length of hospital stay was (9.3±1.8) d. 16 patients developed postoperative complications including 3 cases of pulmonary infections, 5 biliary leakage, 2 postoperative bleeding and 6 pleural effusion. All these cases were cured after conservative treatments. No death was observed during the perioperative period. Conclusions Compared with the traditional open hepatectomy, laparoscopic hepatectomy can obtain a more explicit and closer visual field under direct, amplifying vision. Laparoscopic hepatectomy is a safe, feasible and effective treatment for hepatolithiasis when surgeons are skilled in laparoscopic and hepatic surgical techniques. Key words: Hepatectomy; Laparoscopes; Hepatolithiasis