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Laparoscopic anatomical left hemihepatectomy guided by middle hepatic vein in the treatment of left hepatolithiasis with a history of upper abdominal surgery

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Abstract

Background

This study aimed to investigate the safety and efficacy of laparoscopic anatomical left hemihepatectomy guided by the middle hepatic vein (MHV) for the treatment of patients with hepatolithiasis who had a history of upper abdominal surgery.

Methods

Retrospective data analysis was performed on patients who underwent laparoscopic left hepatectomy for hepatolithiasis and with previous upper abdominal surgery at the Second Affiliated Hospital of Nanchang University from January 2018 to April 2022. According to the different surgical approaches, patients were divided into laparoscopic anatomical left hepatectomy guided by the MHV group (MHV-AH group) and laparoscopic traditional anatomical left hepatectomy not guided by the MHV group (non-MHV-AH group).

Results

This study included 81 patients, with 37 and 44 patients in the MHV-AH and non-MHV-AH groups, respectively. There was no significant difference in the basic information between the two groups. Five cases were converted to laparotomy, and the remaining were successfully completed under laparoscopy. Compared to the non-MHV-AH group, the MHV-AH group had a slightly longer operation time (319.30 min vs 273.93 min, P = 0.032), lower bile leakage rate (5.4% vs 20.5%, P = 0.047), stone residual rate (2.7% vs 20.5%, P = 0.015), stone recurrence rate (5.4% vs 22.7%, P = 0.028), and cholangitis recurrence rate (2.7% vs 22.7%, P = 0.008).There were no significant differences in the results of other observation indices between the groups.

Conclusions

Laparoscopic anatomical left hepatectomy guided by the MHV is safe and effective in the treatment of left hepatolithiasis with a history of upper abdominal surgery. It does not increase intraoperative bleeding and reduces the risk of postoperative bile leakage, residual stones, stone recurrence, and cholangitis recurrence.

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Acknowledgements

We would like to thank the contributions of all of the patients in our study. This research was funded by grants from the National Natural Science Foundation of China (No.82160578); the Natural Science Foundation of Jiangxi Province, China (No. 20232BAB216076 and 20202BAB216029); the Health Department of Jiangxi Province, China (No.20201066 and 202210033); and the Research Project of Education Department of Jiangxi Province, China (No.GJJ2200227).

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Author notes

  1. Yuting Fan, Jian Huang and Liangzhi Xu have contributed equally to the work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China

    Yuting Fan, Jian Huang, Liangzhi Xu, Qi Xu, Xinguo Tang, Kangpeng Zheng, Wei Hu, Jinghang Liu, Jiyang Wang, Tiande Liu, Bo Liang, Hu Xiong, Wen Li, Xiaowei Fu & Lu Fang

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  1. Yuting Fan
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  2. Jian Huang
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  4. Qi Xu
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Correspondence to Xiaowei Fu or Lu Fang.

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Yuting Fan, Jian Huang, Liangzhi Xu, Qi Xu, Xinguo Tang, Kangpeng Zheng, wei Hu, Jinghang Liu, Jiyang Wang, Tiande Liu, Bo Liang, Hu Xiong, Wen Li, Xiaowei Fu, and Lu Fang have no conflict of interest to disclose.

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Fan, Y., Huang, J., Xu, L. et al. Laparoscopic anatomical left hemihepatectomy guided by middle hepatic vein in the treatment of left hepatolithiasis with a history of upper abdominal surgery. Surg Endosc 37, 9116–9124 (2023). https://doi.org/10.1007/s00464-023-10458-3

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