Clinical Trials Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2025; 17(5): 105890
Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.105890
Not all reoperative laparoscopic liver resection procedures are feasible for hepatolithiasis patients with a history of biliary surgery
Wen-Jun Zhang, Guang Chen, Da-Fei Dai, Xiao-Peng Chen
Wen-Jun Zhang, Da-Fei Dai, Xiao-Peng Chen, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
Wen-Jun Zhang, Da-Fei Dai, Department of Hepatobiliary Surgery, The Fifth Clinical Medical College of Anhui Medical University, Wuhu 241000, Anhui Province, China
Guang Chen, Department of Pediatrics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
Co-first authors: Wen-Jun Zhang and Guang Chen.
Co-corresponding authors: Xiao-Peng Chen and Da-Fei Dai.
Author contributions: Zhang WJ, Chen G and Dai DF drafted the initial manuscript; Zhang WJ, Dai DF and Chen XP collected the data; Chen G and Chen XP analyzed the data; Chen XP designed the study and critically reviewed the manuscript; all authors have read and approved the final version to be submitted.
Supported by The Key Research and Development Program of Anhui Province of China, No. 1804h08020273; and The Key Research Project of Health Commission of Anhui Province of China, No. AHWJ2022a016.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College (No. [2022]106).
Clinical trial registration statement: This study is registered at ClinicalTrials.gov (www.chictr.org.cn). The registration number is ChiCTR2300072545.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
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: Xiao-Peng Chen, MD, PhD, Professor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, No. 2 Zheshanxi Road, Jinghu District, Wuhu 241000, Anhui Province, China. drchenxp@wnmc.edu.cn
Received: February 10, 2025
Revised: April 4, 2025
Accepted: April 18, 2025
Published online: May 27, 2025
Processing time: 107 Days and 2.5 Hours
Abstract
BACKGROUND

Laparoscopic hepatectomy (LH) has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes. However, reoperative LH (rLH) includes multiple procedures, and the no studies have examined the clinical value of individual laparoscopic procedures.

AIM

To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.

METHODS

Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied. Liver resection procedures were divided into three categories: (1) Laparoscopic/open left lateral sectionectomy [reoperative laparoscopic left lateral sectionectomy (rLLLS)/reoperative open left lateral sectionectomy (rOLLS)]; (2) Laparoscopic/open left hemihepatectomy [reoperative laparoscopic left hemihepatectomy (rLLH)/reoperative open left hemihepatectomy (rOLH)]; and (3) Laparoscopic/open complex hepatectomy [reoperative laparoscopic complex hepatectomy (rLCH)/reoperative open complex hepatectomy (rOCH)]. The clinical outcomes were compared between the rLLLS, rLLH, and rLCH groups, and subgroup analyses were performed for the rLLLS/rOLLS, rLLH/rOLH, and rLCH/rOCH subgroups.

RESULTS

A total of 185 patients were studied, including 101 rLH patients (40 rLLLS, 50 rLLH, and 11 rLCH) and 84 reoperative open hepatectomy (40 rOLLS, 33 rOLH, and 11 rOCH). Among the three types of rLH procedure, rLLLS required the shortest operation time (240.0 minutes vs 325.0 minutes vs 350.0 minutes, P = 0.001) and the lowest blood transfusion rate (10.0% vs 22.0% vs 54.5%, P = 0.005), followed by rLLH. The rLCH had the highest conversion rate (P < 0.05) and postoperative intensive care unit stay rate (P = 0.001). Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery, while there were no differences in all outcomes between the rLCH and rOCH subgroups.

CONCLUSION

The rLH is safe for hepatolithiasis patients with a history of biliary surgery. The rLLLS and rLLH can be recommended for these patients, whereas rLCH should be applied with caution.

Keywords: Hepatolithiasis; Laparoscopic hepatectomy; Previous biliary surgery; Reoperation; Conversion

Core Tip: This study aimed to evaluate the safety and feasibility of three types of reoperative laparoscopic hepatectomy procedures in patientsfor with hepatolithiasis and a history of biliary surgery. Among the three procedures, reoperative laparoscopic left lateral sectionectomy (rLLLS) had the most favorable clinical outcomes, followed by reoperative laparoscopic left hemihepatectomy (rLLH). However, reoperative laparoscopic complex hepatectomy (rLCH) had the lowest clinical value. The majority of clinical outcomes in rLLLS and rLLH patients were either superior or equivalent to those in the corresponding open procedures, while rLCH did not offer any advantages over the corresponding open surgery. Therefore, rLLLS and rLLH are recommended for these patients, while rLCH should be used with caution.