Laparoscopic vs open surgery for complex hepatolithiasis: A retrospective comparative study

doi:10.4254/wjh.v17.i11.110050

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 17, Issue 11

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (53)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-2) series, Tables (1-3) series.

Item

Count

PDF

HTML

Figures (1-2)

Tables (1-3)

Sum=49

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=4

Nov 27, 2025 (publication date) through Dec 4, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Hepatology

ISSN

1948-5182

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Hepatol. Nov 27, 2025; 17(11): 110050
Published online Nov 27, 2025. doi: 10.4254/wjh.v17.i11.110050

Laparoscopic vs open surgery for complex hepatolithiasis: A retrospective comparative study

De-Xin Lin, Xin-Bin Zhuo, Gui-Jian Chang, Wen-De Lei, Jian Huang, Yong Zhang, Zheng-Jun Qiu, Shi-Yan Zhang

De-Xin Lin, Xin-Bin Zhuo, Gui-Jian Chang, Wen-De Lei, Jian Huang, Yong Zhang, Department of Hepatobiliary, Pancreatic and Splenic Surgery, Ningde Clinical Medicine of Fujian Medical University, Ningde 352100, Fujian Province, China

De-Xin Lin, Xin-Bin Zhuo, Gui-Jian Chang, Wen-De Lei, Jian Huang, Yong Zhang, Department of Hepatobiliary, Pancreatic and Splenic Surgery, Ningde Municipal Hospital, Ningde Normal University, Ningde 352100, Fujian Province, China

Zheng-Jun Qiu, General Surgery Center, The First People’s Hospital Affiliated with Shanghai Jiao Tong University, Shanghai 200080, Shanghai Province, China

Shi-Yan Zhang, Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding 355200, Fujian Province, China

Co-corresponding authors: De-Xin Lin and Shi-Yan Zhang.

Author contributions: Lin DX conceptualized and designed the study, performed surgical procedures, and critically revised it for intellectual content; Zhuo XB assisted in surgical interventions, managed postoperative patient follow-up, and contributed to clinical data acquisition; Chang GJ conducted literature reviews, ensured ethical compliance, and contributed to manuscript preparation and editing; Lei WD participated in data curation, preoperative patient assessments; Huang J supervised the study, interpreted imaging and clinical data, and provided critical revisions to the manuscript; Zhang Y provided technical expertise in intraoperative imaging and visualization techniques; Qiu ZJ and Zhang SY conducted data collection, statistical analysis, and interpretation of the results; Lin DX, Lei WD, and Zhang SY drafted the manuscript; Lin DX and Zhang SY contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.

Supported by the Fujian Natural Science Foundation, China, No. 2021J011164.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Ningde Municipal Hospital, Ningde Normal University, approval No. 20211009.

Informed consent statement: Informed consent was acquired from all study participants and/or their legal guardians.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: De-Xin Lin, MD, Director, Professor, Department of Hepatobiliary, Pancreatic and Splenic Surgery, Ningde Clinical Medicine of Fujian Medical University, No. 13 Mindong East Road, Jiaocheng District, Ningde 352100, Fujian Province, China. ldx556@126.com

Received: May 28, 2025
Revised: June 18, 2025
Accepted: October 9, 2025
Published online: November 27, 2025
Processing time: 183 Days and 1.5 Hours

Abstract

BACKGROUND

Laparoscopic surgery is increasingly used for complex hepatolithiasis; however, data on laparoscopic vs open surgery remain limited. This study was undertaken to test the hypothesis that laparoscopic surgery offers comparable safety and efficacy to open surgery, with added benefits in recovery outcomes.

AIM

To compare clinical outcomes between laparoscopic and open approaches in complex hepatolithiasis.

METHODS

This retrospective cohort study was conducted at Ningde Municipal Hospital, a tertiary care center, and included 80 patients with complex hepatolithiasis treated between January 2020 and August 2024. Patients were non-randomly allocated to laparoscopic (n = 40) or open surgery (n = 40) groups based on the treatment period. Clinical, intraoperative, and postoperative data were analyzed using appropriate parametric or non-parametric tests; categorical data were analyzed using χ² or Fisher’s exact test.

RESULTS

Laparoscopic surgery was associated with a longer median operative time (250.0 minutes vs 207.0 minutes, P = 0.003) but shorter postoperative hospital stay (9.0 days vs 14.0 days, P < 0.001) compared to open surgery. Wound infection rates were significantly less frequent in the laparoscopic group (5.0% vs 22.5%, P = 0.023). Stone clearance rates and overall complications were comparable. One case of perioperative mortality occurred in the open surgery cohort.

CONCLUSION

Laparoscopic surgery is a feasible and safe alternative to open surgery for complex hepatolithiasis, offering faster recovery and reduced wound-related complications.

Keywords: Laparoscopic surgery; Complex hepatolithiasis; Liver resection; Safety; Laennec’s capsule; Surgical outcomes

Core Tip: This retrospective study compares laparoscopic and open surgical approaches for complex hepatolithiasis, a challenging condition involving intrahepatic bile duct stones and anatomical distortions. Despite a longer operative time, laparoscopic surgery resulted in significantly shorter hospital stays and lower wound infection rates, while maintaining similar stone clearance and complication rates. The study highlights the feasibility and safety of minimally invasive liver surgery in high-risk patients when performed under strict adherence to surgical indication selection criteria, skillful utilization of anatomical characteristics of Laennec’s capsule of the liver, and standardized operative protocols.