[Clinical outcomes of minimally invasive anatomical hepatectomy guided by the hepatic vein combined with transhepatic duct lithotomy for the treatment of complex hepatolithiasis].

Objective

To investigate the clinical efficacy of minimally invasive anatomical hepatectomy guided by the major hepatic vein combined with transhepatic duct lithotomy (MATL) for the treatment of complex intrahepatic bile duct stones.

Methods

This is a retrospective case series study. Clinical data of 361 patients who underwent minimally invasive MATL for complex intrahepatic bile duct stones from January 2016 to September 2025 at the Department of Hepatobiliary and Pancreatic Surgery, Fuzhou University Affiliated Provincial Hospital were retrospectively analyzed. The patients included 126 males and 235 females, with an age of (52.4±9.9) years (range: 20 to 85 years). Among them, 329 cases were treated with laparoscopic surgery and 32 cases with robotic surgery. The surgical time, intraoperative blood loss, resection extent, complications, postoperative hospitalization duration, and stone clearance and recurrence were recorded for both groups. Logistic univariate and multivariate regression analyses were performed to identify independent factors influencing complication occurrence.

Results

The total surgical time (M (IQR)) was 263 (91) min (range: 100 to 480 min), and the total blood loss was 196 (70) ml (range: 61 to 356 ml). The resection extent included 249 cases of left hemihepatectomy, 54 cases of right hemihepatectomy, and 58 cases of segmental hepatectomy. Stone extraction was performed via the bile duct end in 353 cases and via the common bile duct in 8 cases. In the laparoscopic group, 1 case was missected the left hepatic duct during surgery and required laparotomy for biliary-enteric anastomosis. A total of 40 cases (11.1%) developed postoperative complications, including 19 cases of bile fistula (5.3%, 17 Grade A, 1 Grade B, and 1 Grade C), and 1 case of perioperative mortality. The postoperative hospitalization duration was (5.9±1.7) d (range: 3 to 12 d). CT findings prior to discharge indicated residual calculi in 7 cases, all from the laparoscopic group. As of October 2025, follow-up was completed for all 361 patients. The follow-up duration was 52(32)months (range:1 to 117 months), with 11 cases (3.0%) experiencing recurrence. Logistic regression analysis revealed that resection method (segmental hepatic resection) was an independent risk factor for complications (P<0.05).

Conclusion

Minimally invasive MATL surgery achieves precise resection of the affected bile duct basin by leveraging the anatomical relationship between the diseased bile duct and hepatic veins, demonstrating high stone clearance rates, low recurrence rates, and reduced incidence of bile fistula.