Comparison Of Laparoscopic Hepatectomy And Open Hepatectomy

Objective: Laparoscopic hepatectomy(LH)was successfully reported for the first time since Reich in 1991.It has developed rapidly with advances in equipment and minimally invasive techniques for surgeons.The scope of surgery has gradually progressed to lobectomy of liver and hemihepatectomy.Meanwhile,the increasing status of liver diseases in surgical treatment has led to the gradual establishment of enhanced recovery after surgery concepts in the treatment of liver diseases.This study retrospectively analyzed patients who were performed with LH or open hepatectomy(OH)at the Department of Hepatobiliary and Pancreatic Surgery in Qingdao University Affiliated Hospital.We evaluated the pros and cons of LH and OH,the short-term efficacy of LH,and whether it was feasible to apply ERAS measures collaboratively.By comparing clinical data between different groups,it was proved that LH is safe and effective in the treatment of liver diseases,and it can improve ERAS.Methods: The retrospective analysed 250 patients with malignant liver disease after LH or OH at the Department of Hepatobiliary and Pancreatic Surgery in Qingdao University Affiliated Hospital from 2015.06 to 2017.09.Randomly selected patients were given partial ERAS.According to different types of surgical methods,and whether used collaborative ERAS during perioperative period,these patients were divided into four groups:the LH-ERAS group,the OH-ERAS group,the LH group,and the OH group.These four groups were observed for the preoperative and postoperative liver function,the operation time,blood transfusion and hepatic hilus occlusion,intraoperative blood loss,and the 8th hour pain index,the 24 th hour pain index,postoperative spontaneous exhaust time,postoperative spontaneous activity time,postoperative hospital stay and complications.Results: Through data analysis,there were no significant significant in terms of age,gender,surgical site,preoperative liver function grading,and tumor diameter among the groups.The intraoperative blood loss,length of hospital stay,postoperative spontaneous exhaust time,recovery time,postoperative liver function and pain index of LH-ERAS group and LH group were lower than those of OH-ERAS group and OH group(P<0.05).The operation time was not statistically significant(P>0.05).Compared with the same operation plan by the different synergy perioperative treatment measures,the collaboration ERAS measures group were better than the traditional group in the hospitalization time,postoperative spontaneous exhaust time,recovery time,and pain index(P<0.05);there was no significant difference between the complication rates of the groups(P>0.05).There were no deaths in those groups.Conclusions: Both LH and OH have good results in the treatment of hepatic malignancy.LH reduces intraoperative trauma,bleeding,length of hospital stay,postoperative spontaneous exhaust time,recovery time,pain index less than OH.So LH is safe,effective and feasible within the scope of standard hepatectomy indications.And ERAS in LH and OH can reduce stress and trauma in varying degrees which fully reflects the core concept of ERAS and its safety and feasibility in liver surgery applications.With collaborative application with ERAS,LH can further speed up postoperative recovery process and reduce the physiological,psychological and economic burdens of patients.Furthermore,on the basis of overall consideration of its own particularity and complexity,clinical practice can generalize perioperative ERAS plan individually applied to the liver surgery patients and promote the development of ERAS in liver surgery.So with collaborative application with ERAS,LH can treat liver diseases more safely,more effectively,more comprehensively,more accurately,and more quickly.