title: Laparoscopic Versus Open Left-Sided Hepatectomy for Hepatolithiasis: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Although laparoscopic left hepatectomy (LLH) for hepatolithiasis had been successfully performed in a series of cases, its advantages over open left hepatectomy (OLH) are still uncertain. This meta-analysis is to compare the clinical outcomes of LLH with those of OLH.
  
  
  METHODS
  A systematic literature research was performed to identify comparative studies on LLH versus OLH for hepatolithiasis from January 1991 to May 2016. Operative outcomes, postoperative outcomes, and gallstone clearance rate were evaluated. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated using fixed-effect or random-effect models.
  
  
  RESULTS
  Eight studies, including one randomized controlled trial (RCT) and seven nonrandomized observational clinical studies, met the inclusion criteria. There were 739 patients in this meta-analysis, including 316 LLHs and 423 OLHs. The volume of intraoperative blood loss favored LLH (P = .015). Intraoperative transfusion (P < .001), overall complication (P < .001), and hospital stay (P = .001) were significantly low in LLH. There was no obvious difference in operation time, residual stone rate, and recurrent stone rate. The mean conversion rate was 9.5% (range, 2.2%-15.6%).
  
  
  CONCLUSIONS
  LLH seems to be more effective and safer for selected patients with hepatolithiasis than OLH. As only one RCT was included, the evidence of which is still limited. More prospective, multicenter, and RCTs are needed to further define the real role of the laparoscopic technique in hepatolithiasis.
authors.affiliation: Department of General Surgery, The First Affiliated Hospital, Nanchang University , Nanchang, China .
authors.forename: Long
authors.initials: L
authors.lastname: Peng
authors.affiliation: Department of General Surgery, The First Affiliated Hospital, Nanchang University , Nanchang, China .
authors.forename: Jian
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of General Surgery, The First Affiliated Hospital, Nanchang University , Nanchang, China .
authors.forename: Zhanying
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of General Surgery, The First Affiliated Hospital, Nanchang University , Nanchang, China .
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of General Surgery, The First Affiliated Hospital, Nanchang University , Nanchang, China .
authors.forename: Weidong
authors.initials: W
authors.lastname: Xiao
mesh_terms: D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D016063:Blood Loss, Surgical; D042882:Gallstones / Q000601:surgery; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D020347:Lithiasis / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D061646:Operative Time; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: gallstone clearance rate; hepatolithiasis; laparoscopic left-sided hepatectomy; meta-analysis