Reoperative Laparoscopic Liver Resection for Hepatolithiasis Patients With a History of Biliary Surgery: A Cohort Study.

INTRODUCTION

It is unclear whether laparoscopic hepatectomy for hepatolithiasis patients with a history of biliary surgery achieves favorable clinical outcomes. This study aimed to evaluate the safety and feasibility of reoperative laparoscopic hepatectomy (rLH).

METHODS

Patients who underwent anatomical liver resection for hepatolithiasis between 2015 and 2022 were included in the study. The clinical outcomes of rLH were compared with those of reoperative open hepatectomy (rOH) and initial laparoscopic hepatectomy (iLH). To ensure balanced baseline characteristics, propensity score matching was performed.

RESULTS

A total of 311 patients undergoing anatomical hepatectomy combined with biliary exploration for hepatolithiasis were studied, which included 84 rOH, 101 rLH, and 127 iLH. Propensity score matching resulted in 86 patients in both iLH (miLH) and rLH (mrLH) groups. Compared with the miLH group, the mrLH group had a higher conversion rate (14.0% versus 3.5%, P < 0.001), a higher 90-d complication rate (52.3% versus 34.9%, P = 0.035), and a lower stone clearance rate (initial, 76.2% versus 89.9%, P = 0.024; final, 81.0% versus 93.7%, P = 0.021). However, when compared with the rOH group, the rLH group required a lower blood transfusion rate (20.8% versus 39.3%, P = 0.006), a shorter median postoperative hospital stay (8.0 versus 11.0 d, P < 0.001), and a lower stone recurrence rate (4.9% versus 25.8%, P < 0.001), except for a longer median operation duration (300.0 versus 240.0 min, P < 0.001). No significant differences were found in other clinical outcomes.

CONCLUSIONS

rLH is a safe and feasible option for selected patients with hepatolithiasis who have previously undergone biliary surgery, although its overall clinical benefit is inferior to that of iLH. It should be carefully performed by surgeons with rich experience in laparoscopic liver resection in large medical centers.