title: Laparoscopic hepatectomy is associated with a higher incident frequency in hepatolithiasis patients.
abstract: OBJECTIVE
  The primary concern regarding laparoscopic hepatectomy in hepatolithiasis patients is surgical safety, which may be high in current practice.
  
  
  METHODS
  Hepatolithiasis patients who underwent laparoscopic and laparotomic hepatectomies were retrospectively studies after being matched for age, location of gallstones, liver resection and underlying liver conditions at a ratio of 1:1 (n = 44 in each group). The rates of intraoperative incidents and postoperative complications were examined using validated classification and grading systems. The primary outcome measure was the procedure-related complication/mortality rate.
  
  
  RESULTS
  Laparoscopy was converted to open surgery in three patients (6.8 %). The length of the operation for laparoscopic hepatectomy was significantly longer than that for laparotomic hepatectomy (277.5 min [range, 190-410 min] vs. 212.5 min [140-315 min], P < 0.001). The two groups had similar intraoperative blood loss (367.5 mL [150-1200 mL] vs. 392.5 mL [200-1400 mL], P > 0.05) and transfusion frequencies (13.6 vs. 18.2 %, P > 0.05). The laparoscopy group had a higher percentage of patients with at least one intraoperative incident compared with the laparotomy group (22.7 vs. 6.8 %; P < 0.05). Vascular events occurred in nine patients (20.5 %) undergoing laparoscopy and two patients (4.5 %) undergoing laparotomy (OR 5.4 [95 %CI, 1.1-26.7], P < 0.05).
  
  
  CONCLUSIONS
  Laparoscopic hepatectomy is associated with a higher risk of intraoperative vascular incidents in hepatolithiasis patients compared wit laparotomy.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Mingde Road, Nanchang, 330006, China, nczhoufan@hotmail.com.
authors.forename: Fan
authors.initials: F
authors.lastname: Zhou
authors.forename: Jiang-hua
authors.initials: JH
authors.lastname: Shao
authors.forename: Shu-bing
authors.initials: SB
authors.lastname: Zou
authors.forename: Ming-wen
authors.initials: MW
authors.lastname: Huang
authors.forename: Xiang-bao
authors.initials: XB
authors.lastname: Yin
authors.forename: Xin
authors.initials: X
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D020347:Lithiasis / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D055815:Young Adult