Laparoscopic hepatectomy based on diseased bile duct tree territory guided by double landmarks for hepatolithiasis: A case report.

Background: Complex hepatolithiasis has a high perioperative risk and recurrence rate. Currently, standardized treatment protocols and reliable anatomical landmarks remain undefined, posing considerable challenges for laparoscopic hepatectomy in these cases. Achieving complete stone clearance and addressing hilar bile duct stenosis are critical determinants of surgical efficacy in hepatolithiasis management.

Case summary: We present the case of a woman with intrahepatic and extrahepatic bile duct stones and chronic cholangitis who underwent laparoscopic hepatectomy. Hepatic segments I, II, III, IV, VI, and VII of the diseased bile duct tree and bile duct cyst were resected according to the preoperative plan, plastic repair of the hilar bile duct was performed, and the repaired bile duct was anastomosed with the jejunum. The patient achieved a favorable prognosis and long-term survival.

Conclusion: Based on segmental/subsegmental diseased bile duct tree territory hepatectomy and hilar stenosis relief, laparoscopic hepatectomy for complex hepatolithiasis can be safely performed guided by double landmarks (diseased bile duct/hepatic vein).