Clinical experiences of laparoscopic anatomical hepatectomy for hepatolithiasis

Abstract

Objective To assess the feasibility, safety of laparoscopic anatomical hepatectomy for hepatolithiasis. Methods Thirty-five patients with hepatolithiasis from the Third Xiangya Hospital of Central South University, March 2008 to March 2012 underwent ultrasound and computed tomography (CT) or magnetic resonance cholangiopancreatography (MRCP) to confirm the position of intrahepatic bile duct stones and situation of liver atrophy and cirrhosis. Laparoscopic anatomical hepatectomy were performed in the 35 patients. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. The operative time, intraoperative blood loss, intraoperative and postoperative complications were recorded and the feasibility, safety and treatment effects of laparoscopic anatomical hepatectomy were analyzed. Results Nine of the 35 patients underwent partial liver resection and 23 patients underwent left lobe resection, choledocholithotomy drainage and cholecystectomy. Three patients underwent left lobe, partial hepatic segmentⅤresection plus choledocholithotomy drainage. Laparoscopic anatomical hepatectomy was successfully carried out in all the patients. The average operative time was 184 minutes and the blood loss was 341 ml. The mean hospital stay was 6.5 days after surgery. The Peritoneal drainage tube indwelling time was 2 to 4 days. Five patients developed biliary fistula after operation. One patient developed liver section abscess. All patients recovered by sufficient drainage. No complications of hemorrhage and subphrenic abscess occured. All patients were followed up without recurrence of hepatolithiasis and residual stones. Conclusions Laparoscopic anatomical hepatectomy in treating hepatolithiasis is feasible, safe and clinically applicable. It can be a new choice for the treatment of hepatolithiasis. Key words: Laparoscopy; Anatomical hepatectomy; Hepatolithiasis; Minimally invasive techniques