Comparison Of Laparoscopic Versus Open Hepatectomy For Left-Sided Hepatolithiasis

Objective: To compare the efficacy of laparoscopic and open hepatectomy on the treatment of left-sided hepatolithiasis.Methods: From May 2013 to December 2015, the clinical data of 54 patients(40.40%) who underwent laparoscopic hepatectomy(laparoscopic group) and 79 patients(59.60%) who underwent open hepatectomy(open group) for left intrahepatic duct stones in Fujian Shengli hospital were retrospectively analyzed. We compared their perioperative and clinical outcomes, including operative time, intraoperative blood loss, transfusion cases,postoperative eating date, the time of gastrointestinal function recovery, off-bed activity time, the time of postoperative pain control, hospital stay, postoperative complication, and the change of leukocyte(WBC), neutrophils(NE), hemoglobin(HB), albumin(ALB), total bilirubin(TBIL), alanine aminotransferase(ALT), aspartate aminotransferase(AST) at postoperative day 1,day 4,day 7,and the day before leaving hospital.Results: The operative time of laparoscopic group was significantly longer than that of open group( P < 0.05), while the two groups has no significant difference in intraoperative blood loss and transfusion cases(P > 0.05). The postoperative eating date, the time of gastrointestinal function recovery, off-bed activity time after surgery, the time of postoperative pain control and hospital stay in laparoscopic group was significantly shorter than that of open group(P<0.05). No difference was found in WBC, NE, HB, ALB, TBIL, ALT, AST at postoperative day 1,day 4,day 7,and the day before leaving hospital between the two groups(P>0.05). There were 9 patients hapended complications in laparoscopic group, including 3 cases of residual stones, 1 case of biliary fistula, 6 cases of pneumonia, 1 case of abdominal infection, 1 case of peritoneal effusion, 1 case of sepsis, 2 cases of incision infection, 2 cases of secondary suture for secondary. The total complication rate was 16.67%. There were 26 patients hapended complications in open group, including 5 cases of residual stones, 1 case of biliary fistula, 11 cases of pneumonia, 4 cases of abdominal infection, 4 cases of peritoneal effusion, 1 case of sepsis, 13 cases of incision infection, 8 cases of secondary suture for secondary. The total complication rate was 32.91 %. The incidence of postoperative complications of laparoscopic group less than open group, and there was a significant difference of complications(P < 0.05).Conclusions: In left-sided hepatolithiasis, laparoscopic hepatectomy was safe and reliable. Compared with the traditional open hepatectomy, it had a advantage for small surgical trauma, less postoperative complications, fast recovery. By improving the technology and experience of laparoscopic operation, grasping the indications and contraindications of laparoscopic hepatectomy strictly, laparoscopic hepatectomy was sure to benefit more patients with intrahepatic bile duct stones.