Laparoscopy is nowadays considered as the standard approach for hepatic left lateral sectionectomy (LLS), but its value in the prevention of incisional hernia (IH) has not been demonstrated.
Between 2012 and 2017, patients undergoing laparoscopic (LLLS) or open LLS (OLLS) in 8 centers were compared. Patients undergoing a simultaneous major abdominal procedure were excluded. The incidence of IH was assessed clinically and morphologically on computed tomography (CT) using inverse probability of treatment weighting (IPTW) and multivariable regression analysis.
After IPTW, 84 LLLS were compared to 48 OLLS. Compared to OLLS, LLLS patients had reduced blood loss (100 [IQR: 50–200] ml vs. 150 [IQR: 50–415] ml, p = 0.023) and shorter median hospital stay (5 [IQR: 4–7] days vs. 7 [6–9] days, p < 0.001), but experienced similar rate of postoperative complications (mean comprehensive complication index: 12 ± 19 after OLLS versus 13 ± 20 after LLLS, p = 0.968). Long-term radiological screening was performed with a median follow-up of 27.4 (12.1–44.9) months. There was no difference between the two groups in terms of clinically relevant IH (10.7% [n = 9] after LLLS, 8.3% [n = 4] after OLLS, p = 0.768). The rate of IH detected on computed tomography was lower after LLLS than after OLLS (11.9% [n = 10] versus 29.2% [n = 14], p = 0.013). On multivariable analysis, the laparoscopic approach was the only independent factor influencing the risk of morphological IH (OR = 0.290 [95% CI: 0.094–0.891], p = 0.031). The 2 preferential sites for specimen extraction after LLLS were Pfannenstiel and midline incisions, with rates of IH across the extraction site of 2.3% [n = 1/44] and 23.8% [n = 5/21], respectively (p = 0.011).
The laparoscopic approach for LLS decreases the risk of long-term IH as evidenced on morphological examinations, with limited clinical impact. Pfannenstiel’s incision should be preferred to midline incision for specimen extraction after LLLS.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Farges O, Goutte N, Dokmak S, Bendersky N, Falissard B, Group A-FHS (2014) How surgical technology translates into practice: the model of laparoscopic liver resections performed in France. Ann Surg 260:916–922. https://doi.org/10.1097/sla.0000000000000950
Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker C-G, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery. Ann Surg 250:825–830. https://doi.org/10.1097/sla.0b013e3181b3b2d8
Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, van Dam RM, Scatton O, Hilal MA, Belli G, Kwon CHD, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen K-H, Schön MR, Sugioka A, Tang C-N, Herman P, Pekolj J, Chen X-P, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629. https://doi.org/10.1097/sla.0000000000001184
Wakabayashi G (2016) What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg Nutr 5:281–289. https://doi.org/10.21037/hbsn.2016.03.03
Azagra JS, Goergen M, Gilbart E, Jacobs D (1996) Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects. Surg Endosc 10:758–761. https://doi.org/10.1007/bf00193052
Goumard C, Farges O, Laurent A, Cherqui D, Soubrane O, Gayet B, Pessaux P, Pruvot FR, Scatton O, Surgery FA for H, and P (2015) An update on laparoscopic liver resection: the French Hepato-Bilio-Pancreatic Surgery Association statement. J Visc Surg 152:107–112. https://doi.org/10.1016/j.jviscsurg.2015.02.003
Azagra JS, Goergen M, Brondello S, Calmes MO, Philippe P, Schmitz B (2009) Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the “gold standard”. J Hepatobiliary Pancreat Surg 16:422–426. https://doi.org/10.1007/s00534-009-0117-3
Ogiso S, Nomi T, Araki K, Conrad C, Hatano E, Uemoto S, Fuks D, Gayet B (2015) Laparoscopy-specific surgical concepts for hepatectomy based on the laparoscopic caudal view: a key to reboot surgeons’ minds. Ann Surg Oncol 22:S327–S333. https://doi.org/10.1245/s10434-015-4661-6
Shin YC, Jang J-Y, Kang MJ, Jung W, Chang J, Chang YR, Kim S-W (2016) Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones. Surg Endosc 30:259–265. https://doi.org/10.1007/s00464-015-4200-3
Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez P-L (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196:236–242. https://doi.org/10.1016/s1072-7515(02)01622-8
Dokmak S, Raut V, Aussilhou B, Ftériche FS, Farges O, Sauvanet A, Belghiti J (2014) Laparoscopic left lateral resection is the gold standard for benign liver lesions: a case-control study. HPB (Oxford) 16:183–187. https://doi.org/10.1111/hpb.12108
Ding G, Cai W, Qin M (2015) Pure laparoscopic versus open liver resection in treatment of hepatolithiasis within the left lobes: a randomized trial study. Surg Lap Endosc Percut Tech 25:392–394. https://doi.org/10.1097/sle.0000000000000120
Wong-Lun-Hing EM, van Dam RM, van Breukelen GJP, Tanis PJ, Ratti F, van Hillegersberg R, Slooter GD, de Wilt JHW, Liem MSL, de Boer MT, Klaase JM, Neumann UP, Aldrighetti LA, Dejong CHC, Group OIC (2017) Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study). Brit J Surg 104:525–535. https://doi.org/10.1002/bjs.10438
Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tønnessen TI, Abildgaard A, Barkhatov L, Yaqub S, Røsok BI, Bjørnbeth BA, Andersen MH, Flatmark K, Aas E, Edwin B (2018) Laparoscopic versus open resection for colorectal liver metastases. Ann Surg 267:199–207. https://doi.org/10.1097/sla.0000000000002353
Witowski J, Rubinkiewicz M, Mizera M, Wysocki M, Gajewska N, Sitkowski M, Małczak P, Major P, Budzyński A, Pędziwiatr M (2019) Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients. Surg Endosc 33:1491–1507. https://doi.org/10.1007/s00464-018-6431-6
Macacari RL, Coelho FF, Bernardo WM, Krüger JAP, Jeismann VB, Fonseca GM, Cesconetto DM, Cecconello I, Herman P (2019) Laparoscopic vs. open left lateral sectionectomy: an update meta-analysis of randomized and non-randomized controlled trials. Int J Surg 61:1–10. https://doi.org/10.1016/j.ijsu.2018.11.021
Guilbaud T, Feretti C, Holowko W, Garbarino GM, Marchese U, Sarran A, Beaussier M, Gayet B, Fuks D (2020) Laparoscopic major hepatectomy: do not underestimate the impact of specimen extraction site. World J Surg 44:1223–1230. https://doi.org/10.1007/s00268-019-05285-4
Wabitsch S, Schulz P, Fröschle F, Kästner A, Fehrenbach U, Benzing C, Haber PK, Denecke T, Pratschke J, Fikatas P, Schmelzle M (2020) Incidence of incisional hernia after laparoscopic liver resection. Surg Endosc 261:619. https://doi.org/10.1007/s00464-020-07475-x
Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RK (2001) Classification and surgical treatment of incisional hernia Results of an experts’ meeting. Langenbecks Arch Surg 386:65–73. https://doi.org/10.1007/s004230000182
Lunceford JK, Davidian M (2004) Stratification and weighting via the propensity score in estimation of causal treatment effects: a comparative study. Stat Med 23:2937–2960. https://doi.org/10.1002/sim.1903
Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424. https://doi.org/10.1080/00273171.2011.568786
Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34:3661–3679. https://doi.org/10.1002/sim.6607
Xu S, Ross C, Raebel MA, Shetterly S, Blanchette C, Smith D (2010) Use of stabilized inverse propensity scores as weights to directly estimate relative risk and its confidence intervals. Value Health 13:273–277. https://doi.org/10.1111/j.1524-4733.2009.00671.x
Liu Z, Ding H, Xiong X, Huang Y (2018) Laparoscopic left lateral hepatic sectionectomy was expected to be the standard for the treatment of left hepatic lobe lesions: a meta-analysis. Medicine 97:e9835. https://doi.org/10.1097/md.0000000000009835
Kawaguchi Y, Fuks D, Kokudo N, Gayet B (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17. https://doi.org/10.1097/sla.0000000000002176
Tanaka S, Kubo S, Kanazawa A, Takeda Y, Hirokawa F, Nitta H, Nakajima T, Kaizu T, Kaneko H, Wakabayashi G (2017) Validation of a difficulty scoring system for laparoscopic liver resection: a multicenter analysis by the endoscopic liver surgery study group in Japan. J Am Coll Surg 225:249–258.e1. https://doi.org/10.1016/j.jamcollsurg.2017.03.016
Mohkam K, Fuks D, Vibert E, Nomi T, Cauchy F, Kawaguchi Y, Boleslawski E, Regimbeau JM, Gayet B, Mabrut J-Y (2018) External validation and optimization of the french association of hepatopancreatobiliary surgery and transplantation’s score to predict severe postoperative biliary leakage after open or laparoscopic liver resection. J Am Coll Surg 226:1137–1146. https://doi.org/10.1016/j.jamcollsurg.2018.03.024
This study was funded by a grant (PHRC AOM 11060) awarded by the French Ministry of Health.
This study was funded by a grant (PHRC AOM 11060) awarded by the French Ministry of Health.
Drs Benjamin Darnis, Kayvan Mohkam, Nicolas Golse, Eric Vibert, Daniel Cherqui, François Cauchy, Olivier Soubrane, Jean-Marc Regimbeau, Jeanne Dembinski, Jean Hardwigsen, Philippe Bachelier, Christophe Laurent, Stéphanie Truant, Guillaume Millet, Mickaël Lesurtel, Emmanuel Boleslawksi, and Jean-Yves Mabrut have no conflict of interest or financial ties to disclose.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Darnis, B., Mohkam, K., Golse, N. et al. Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study. Surg Endosc 35, 5034–5042 (2021). https://doi.org/10.1007/s00464-020-07985-8