Comparison of laparoscopic versus open left hemihepatectomy for left-sided hepatolithiasis.
OBJECTIVE
The purpose of this study was to evaluate and compare the perioperative and long-term outcomes of open versus laparoscopic left hemihepatectomy (OLH vs. LLH) for left-sided hepatolithiasis.


METHODS
Between October 2007 and June 2012, 149 patients with left-sided hepatolithiasis who underwent LLH (n = 37) or OLH (n = 112) were evaluated. The perioperative and long-term outcomes that were reviewed included the stone clearance rate, operative morbidity and mortality, and the stone recurrence rate.


RESULTS
The mean operative time of the LLH group was significantly longer than that of the OLH group (257±50.4 minutes vs. 237±75.5 minutes, p = 0.022), but the mean hospital stay was significantly shorter (8.8±4.10 vs. 14.1±4.98 days, p < 0.001). Postoperative complications were noted in four and twenty cases among LLH and OLH patients, respectively (p = 0.982). The initial clearance rate of intrahepatic duct (IHD) stones was 100% and 96.4% in the LLH and OLH groups, respectively, but all remnant stones (n = 4, OLH group) were resolved postoperatively. There were two cases of recurrence of IHD stones in OLH patients, but none in LLH patients (p = 0.281).


CONCLUSIONS
In left-sided hepatolithiasis, LLH was safe and effective: it resulted in low postoperative morbidity, no mortality and a high stone clearance rate, and there were no incidences of recurrence in our study. The potential benefits of LLH include a shorter hospital stay and a faster return to oral intake. If consideration is given to the appropriate indication criteria, including the extent of hepatectomy and the location and distribution of lesions, LLH may be an excellent choice for treatment of left-sided hepatolithiasis.
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jung-Man
JM
Namgoong
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Ki-Hun
KH
Kim
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Gil-Chun
GC
Park
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Dong-Hwan
DH
Jung
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Gi-Won
GW
Song
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Tae-Yong
TY
Ha
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Duk-Bok
DB
Moon
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Chul-Soo
CS
Ahn
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Shin
S
Hwang
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sung-Gyu
SG
Lee
D000328:Adult; D001653:Bile Ducts, Intrahepatic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D020347:Lithiasis / Q000473:pathology / Q000601:surgery*; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008107:Liver Diseases / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome
Laparoscopic left hemihepatectomy; intrahepatic duct stone; left-sided hepatolithiasis; minimal invasive surgery; open left hemihepatectomy