title: The safety and feasibility of reoperation for the treatment of hepatolithiasis by laparoscopic approach.
abstract: BACKGROUND
  Hepatolithiasis removal is associated with high rates of postoperative residual and recurrence, which in some cases may require multiple surgeries. The progress and development of laparoscopic techniques introduced a new way of treating hepatolithiasis. However, the selection criteria for laparoscopic hepatolithiasis surgery, particularly among patients with a history of biliary surgery, remain undetermined. This study aimed to evaluate the safety, feasibility, and efficacy of reoperation for the treatment of hepatolithiasis via a laparoscopic approach.
  
  
  METHODS
  A retrospective analysis of the perioperative course and outcomes was performed on 90 patients who underwent laparoscopic procedures for hepatolithiasis between January 1, 2008, and December 31, 2012. Thirty-eight patients had previous biliary tract operative procedures (PB group) and 52 patients had no previous biliary tract procedures (NPB).
  
  
  RESULTS
  There was no significant difference in operative time (342.3 ± 101.0 vs. 334.1 ± 102.7 min), intraoperative blood loss (561.2 ± 458.8 vs. 546.3 ± 570.5 ml), intraoperative transfusion (15.8 vs. 19.2 %), postoperative hospitalization (12.6 ± 4.2 vs. 13.4 % ± 6.3 days), postoperative complications (18.4 vs. 23.1 %), conversion to open laparotomy (10.5 vs. 9.6 %), or intraoperative stone clearance rate (94.7 vs. 90.4 %). There was also no significant difference in stone recurrence (7.9 vs. 11.5 %) and recurrent cholangitis (5.3 vs. 13.5 %) at a mean of 19 months of follow-up (range, 3-51 months) for PB patients compared to NPB patients. The final stone clearance rate was 100 % in both groups.
  
  
  CONCLUSIONS
  Reoperation for hepatolithiasis by laparoscopic approach is safe and feasible for selected patients who have undergone previous biliary operations.
authors.affiliation: Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Shapingba District, Gaotanyan Road, Chongqing, 400038, China. jtian1984@hotmail.com
authors.forename: Ju
authors.initials: J
authors.lastname: Tian
authors.forename: Jian-wei
authors.initials: JW
authors.lastname: Li
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.forename: Yu-dong
authors.initials: YD
authors.lastname: Fan
authors.forename: Ping
authors.initials: P
authors.lastname: Bie
authors.forename: Shu-guang
authors.initials: SG
authors.lastname: Wang
authors.forename: Shu-guo
authors.initials: SG
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D020347:Lithiasis / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult