Safety And Efficacy Evaluation Of Laparoscopic And Open Hepatectomy For Hepatolithiasis:a Propensity Score Matched Analysis

Objective:The purpose of this study is to compare the safety and efficacy of laparoscopic and open hepatectomy for hepatolithiasis,and to discuss the value of laparoscopic hepatectomy for hepatolithiasis.Methods:The clinicopathological data of 254 patients with hepatolithiasis who underwent laparoscopic or open hepatectomy in our hospital from January 2014 to May 2020 were retrospectively collected.Propensity score matching(PSM)was performed to match baseline characteristics of the two groups,and then the perioperative results and follow-up efficacy were compared between the two groups.Results:1.Comparison of baseline data between the two groups of patients:there were significant differences in age,ASA classification,and history of previous biliary surgery between the two groups of patients before PSM(P<0.05).Each group had 63 patients after PSM with well-balanced baseline characteristics.2.Intraoperative conditions:there was no statistic difference in the type of hepatectomy,combined common bile duct exploration rate,T tube drainage placement rate,operation time,intraoperative transfusion rate and intraoperative accidental injury rate between the two groups.However,the laparoscopic group had significantly lower intraoperative blood loss than the open hepatectomy group[(300 vs.350ml,P=0.001].3.Postoperative results:laparoscopic group had significantly shorter postoperative hospital stay[(10.6±4.1)days vs.(14.0±4.0)days,P<0.001]and shorter time to postoperative oral intake[(1.8±1.1)days vs.(2.9±1.6)days,P<0.001]than the open hepatectomy group.In terms of postoperative complications,there were 16 cases in the laparoscopic group,with an incidence of 25.4%;while the open group had 31 cases,with an incidence of 49.2%,the incidence in the laparoscopic group was significantly lower than that in the open group(P=0.006).There was no significant difference in the initial and final stone clearance between the two groups(P>0.05).The difference in follow-up time between the two groups was not statistically significant[(27.2±12.8)months vs.(26.1±13.4)months,P=0.655].Stone recurrence was found in 5(7.9%)patients in the laparoscopic group and 8(12.7%)patients in the open group during the follow-up period(P=0.380).Conclusion:Laparoscopic hepatectomy is safe and effective for hepatolithiasis with the advantages of less intraoperative blood loss,lower postoperative complications and faster postoperative recovery.