Abstract:

Objective

To explore the method of laparoscopic anatomical liver resection with biliary tree pedicle transaction in the treatment of intrahepatic stones.

Methods

Clinical data of 75 patients who underwent biliary tree pedicle transaction approach for intrahepatic stones from Jan. 2018 to Sep. 2022 at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School were retrospectively analyzed，including 64 cases of laparoscopic anatomical liver resection and 11 cases of robot-assisted surgery.

Results

Among the patients， left hepatectomy was performed in 48 cases （64.0%）， left lateral sectionectomy in 3 cases， right posterior sectionectomy in 7 cases， combined left lateral and right posterior sectionectomy in 4 cases， right hepatectomy in 8 cases， combined caudate lobe resection in 1 case， segmental liver resection in 3 cases； intraoperative diagnosis revealed bile duct cancer at the porta hepatis region in 1 case； 2 cases conversion to open surgery； 6 cases underwent biliary-enteric anastomosis （8.0%）， 24 cases （32.0%）underwent common bile duct exploration. The operation time ranged from 125-525（260 ±75.8） minutes，portal occlusion time ranged from 15-120（46 ±24.9） minutes， target liver pedicle transection time ranged from 5-20 （9.8 ±2.8） minutes， dorsal parenchymal transection time ranged from 1-10 （5.4 ±2.1） minutes， ventral parenchymal transection time ranged from 10-115（40.0 ±24.0） minutes， length of liver cut surface was between 4-17 （9.4 ±2.5） cm and width between 2-8 （5.1 ±1.4） cm. Intraoperative blood loss varied between 50-1 300（325.6 ±302.5） ml； 5（6.7%） cases received blood transfusions；postoperative complications included 5 cases with bile leakage；8 patients with fluid accumulated around surgical site；5 patients underwent ultrasound-guided puncture and drainage；16 cases with postoperative fever， 2 cases with postoperative bleeding，There were no deaths during the perioperative period. Follow-up was conducted for 18-24 months postoperatively， with 2 cases undergoing stone removal through T-tube sinus tract while the remaining patients had no residual stones requiring intervention.

Conclusion

The use of laparoscopic anatomical liver resection with biliary tree pedicle transaction technique for hepatobiliary calculi facilitates surgical procedures and complete removal of lesions in the bile duct tree，reducing residual stones and complications.

Key words: Hepatolithiasis, Anatomical liver resection, Laparoscopic, Laennec approach