Laparoscopic hepaticoplasty using gallbladder as a subcutaneous tunnel for hepatolithiasis.
OBJECTIVE
To investigate the feasibility, efficacy and safety of laparoscopic hepaticoplasty using gallbladder as subcutaneous tunnel and sphincter-of-Oddi preservation for hepatolithiasis.


METHODS
From January 2010 to July 2013, six patients with hepatolithiasis were treated at our institution. All the patients underwent laparoscopic surgery. The procedures included common hepatic duct exploration, stone clearance by fiberoptic choledochoscopy, hilar bile duct hepaticoplasty with preservation of the sphincter of Oddi, anastomosis between the hilar bile duct and neck of the gallbladder, and establishment of a subcutaneous tunnel with the gallbladder. Two patients underwent left lateral hepatectomy simultaneously. Clinical data including operation time, intraoperative blood loss, operative morbidity, hospital mortality, stone clearance, and recurrence rate were analyzed.


RESULTS
All patients successfully completed laparoscopic surgery. The mean length of hospital stay was 4.5 ± 0.9 d (range: 3-6 d). The mean blood loss of the hepatectomy was 450 mL (range: 200-700 mL), and the blood loss of the other four was 137 ± 151 mL (range: 50-400 mL). The mean operative time was 318 ± 68 min (range: 236-450 min). The operative morbidity and hospital mortality were zero. The immediate stone clearance rate was 100%. All patients were followed up for an average of 17 mo (range: 7-36 mo). One of the six patients had abdominal mass with pain, and subcutaneous tunnel cholangiography showed severe gallbladder-biliary anastomotic stricture at 4 mo postoperatively. There was no stone recurrence and no cholangitis during follow-up.


CONCLUSIONS
Laparoscopic hepaticoplasty using gallbladder with a subcutaneous tunnel and preserving the sphincter of Oddi is feasible, safe and effective for hepatholithiasis.
Long Cui, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Long
L
Cui
Long Cui, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Zhi
Z
Xu
Long Cui, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Xiao-Feng
XF
Ling
Long Cui, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Li-Xin
LX
Wang
Long Cui, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Chun-Sheng
CS
Hou
Long Cui, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Gang
G
Wang
Long Cui, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Xiao-Si
XS
Zhou
D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002761:Cholangitis / Q000601:surgery; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D020347:Lithiasis / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012008:Recurrence; D009803:Sphincter of Oddi / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Hepaticoplasty; Hepatolithiasis; Laparoscopy; Minimally invasive surgery; Subcutaneous tunnel