Reoperative Laparoscopic Liver Resection for Hepatolithiasis Patients With a History of Biliary Surgery: A Cohort Study.

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-03-15 DOI:10.1016/j.jss.2025.02.028

Yuan-Lin Yu, Jie Fu, Zhi-Wen Feng, Wei-Dong Zhang, Da-Fei Dai, Min-Tuo Wang, Yun-Feng Zhou, Xiao-Peng Chen

{"title":"Reoperative Laparoscopic Liver Resection for Hepatolithiasis Patients With a History of Biliary Surgery: A Cohort Study.","authors":"Yuan-Lin Yu, Jie Fu, Zhi-Wen Feng, Wei-Dong Zhang, Da-Fei Dai, Min-Tuo Wang, Yun-Feng Zhou, Xiao-Peng Chen","doi":"10.1016/j.jss.2025.02.028","DOIUrl":null,"url":null,"abstract":"Introduction: It is unclear whether laparoscopic hepatectomy for hepatolithiasis patients with a history of biliary surgery achieves favorable clinical outcomes. This study aimed to evaluate the safety and feasibility of reoperative laparoscopic hepatectomy (rLH).Methods: Patients who underwent anatomical liver resection for hepatolithiasis between 2015 and 2022 were included in the study. The clinical outcomes of rLH were compared with those of reoperative open hepatectomy (rOH) and initial laparoscopic hepatectomy (iLH). To ensure balanced baseline characteristics, propensity score matching was performed.Results: A total of 311 patients undergoing anatomical hepatectomy combined with biliary exploration for hepatolithiasis were studied, which included 84 rOH, 101 rLH, and 127 iLH. Propensity score matching resulted in 86 patients in both iLH (miLH) and rLH (mrLH) groups. Compared with the miLH group, the mrLH group had a higher conversion rate (14.0% versus 3.5%, P < 0.001), a higher 90-d complication rate (52.3% versus 34.9%, P = 0.035), and a lower stone clearance rate (initial, 76.2% versus 89.9%, P = 0.024; final, 81.0% versus 93.7%, P = 0.021). However, when compared with the rOH group, the rLH group required a lower blood transfusion rate (20.8% versus 39.3%, P = 0.006), a shorter median postoperative hospital stay (8.0 versus 11.0 d, P < 0.001), and a lower stone recurrence rate (4.9% versus 25.8%, P < 0.001), except for a longer median operation duration (300.0 versus 240.0 min, P < 0.001). No significant differences were found in other clinical outcomes.Conclusions: rLH is a safe and feasible option for selected patients with hepatolithiasis who have previously undergone biliary surgery, although its overall clinical benefit is inferior to that of iLH. It should be carefully performed by surgeons with rich experience in laparoscopic liver resection in large medical centers.","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jss.2025.02.028","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: It is unclear whether laparoscopic hepatectomy for hepatolithiasis patients with a history of biliary surgery achieves favorable clinical outcomes. This study aimed to evaluate the safety and feasibility of reoperative laparoscopic hepatectomy (rLH).

Methods: Patients who underwent anatomical liver resection for hepatolithiasis between 2015 and 2022 were included in the study. The clinical outcomes of rLH were compared with those of reoperative open hepatectomy (rOH) and initial laparoscopic hepatectomy (iLH). To ensure balanced baseline characteristics, propensity score matching was performed.

Results: A total of 311 patients undergoing anatomical hepatectomy combined with biliary exploration for hepatolithiasis were studied, which included 84 rOH, 101 rLH, and 127 iLH. Propensity score matching resulted in 86 patients in both iLH (miLH) and rLH (mrLH) groups. Compared with the miLH group, the mrLH group had a higher conversion rate (14.0% versus 3.5%, P < 0.001), a higher 90-d complication rate (52.3% versus 34.9%, P = 0.035), and a lower stone clearance rate (initial, 76.2% versus 89.9%, P = 0.024; final, 81.0% versus 93.7%, P = 0.021). However, when compared with the rOH group, the rLH group required a lower blood transfusion rate (20.8% versus 39.3%, P = 0.006), a shorter median postoperative hospital stay (8.0 versus 11.0 d, P < 0.001), and a lower stone recurrence rate (4.9% versus 25.8%, P < 0.001), except for a longer median operation duration (300.0 versus 240.0 min, P < 0.001). No significant differences were found in other clinical outcomes.

Conclusions: rLH is a safe and feasible option for selected patients with hepatolithiasis who have previously undergone biliary surgery, although its overall clinical benefit is inferior to that of iLH. It should be carefully performed by surgeons with rich experience in laparoscopic liver resection in large medical centers.

查看原文本刊更多论文

对有胆道手术史的肝胆管结石患者再次进行腹腔镜肝切除术：队列研究

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.