Not all reoperative laparoscopic liver resection procedures are feasible for hepatolithiasis patients with a history of biliary surgery

doi:10.4254/wjh.v17.i5.105890

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World Journal of Hepatology

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1948-5182

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

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World J Hepatol. May 27, 2025; 17(5): 105890
Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.105890

Table 1 Baseline characteristics of the three subgroups, n (%)

Characteristic	Reoperative laparoscopic left lateral sectionectomy (n = 40)	Reoperative laparoscopic left hemihepatectomy (n = 50)	Reoperative laparoscopic complex hepatectomy (n = 11)	χ²/F value	P value
Male	9 (22.5)	16 (32.0)	4 (36.4)	1.333	0.514¹
Age, mean (SD), years	62.3 (11.5)	61.8 (7.8)	60.0 (7.7)	0.261	0.771²
Body mass index > 21.5 kg/m²	18 (45.0)	25 (50.0)	6 (54.5 )	0.402	0.818¹
American Society of Anesthesiologists score 2-3	21 (52.5)	19 (38.0)	5 (45.5)	1.895	0.388¹
Obstructive jaundice	6 (15.0)	11 (22.0)	2 (18.2)	0.716	0.699¹
Benign liver lesions	32 (80.0)	43 (86.0)	9 (81.8)	0.588	0.745¹
Number of previous surgeries > 2	2 (5.0)	1 (2.0)	0 (0.0)	N/A³	0.706
Types of previous procedure				N/A³	0.250
cholecystectomy	29 (72.5)	28 (56.0)	9 (81.8)
Choledochotomy with exploration	11 (27.5)	19 (38.0)	2 (18.0)
Hepatectomy	0 (0.0)	3 (6.0)	0 (0.0)
Types of previous approach				N/A³	0.789
Open surgery	30 (75.0)	40 (80.0)	9 (81.8)
Laparoscopic surgery	9 (22.5)	7 (14.0)	2 (18.0)
Unclear	1 (2.5)	3 (6.0)	0 (0.0)
Interval between last two surgeries				N/A³	0.608
≤ 2 years	3 (7.5)	8 (16.0)	2 (18.2)
> 2 years	30 (75.0)	37 (74.0)	8 (72.7)
Unknown time-interval	7 (17.5)	5 (10.0)	1 (9.1)

¹χ² test was used.

²One-way analysis of variance was used.

³No χ² value was reported for Fisher's exact test.

N/A: Not applicable.

Table 2 Clinical outcomes of the three types of laparoscopic reoperation

Characteristic	Reoperative laparoscopic left lateral sectionectomy (n = 40)	Reoperative laparoscopic left hemihepatectomy (n = 50)	Reoperative laparoscopic complex hepatectomy (n = 11)	χ²/H value	P value
Selective hepatic blood flow occlusion	8/40 (20.0)	47/50 (94.0)⁶	7/11 (63.6)⁶^,⁷	51.364	< 0.001¹
Operation duration, median (IQR), minute	240.0 (196.3-322.5)	325.0 (254.5-387.8)⁶	350.0 (295.0-460.0)⁶	14.508	0.001²
Blood loss, median (IQR), mL	200.0 (75.0-281.2)	200.0 (100.0-400.0)	400.0 (200.0-800.0)	5.837	0.054²
Blood transfusion	4/40 (10.0)	11/50 (22.0)⁶	6/11 (54.5)⁶	10.483	0.005¹
Conversion to open surgery	3/40 (7.5)	8/50 (16.0)	4/11 (36.4)⁶	5.787	0.055¹
Postoperative intensive care unit stay	5/40 (12.5)	10/50 (20.0)	7/11 (63.6)⁶^,⁷	13.426	0.001¹
Postoperative stay, median (IQR), days	8.0 (6.0-10.0)	8.0 (7.0-12.3)	10.0 (7.0-13.0)	2.211	0.331²
Early complications within 90 days	17/40 (42.5)	27/50 (54.0)	7/11 (63.6)	2.028	0.363¹
Major complications within 90 days	2/40 (5.0)	3/50 (6.0)	0/11 (0.0)	N/A³	1.000
Reinterventions within 90 days	2/40 (5.0)	3/50 (6.0)	0/11 (0.0)	N/A³	1.000
Readmission within 90 days	6/40 (15.0)	10/50 (20.0)	3/11 (27.3)	0.942	0.624¹
90-day mortality	0/40 (0.0)	0/50 (0.0)	0/11 (0.0)	-	-
Initial stone clearance⁴	33/40 (82.5)	36/48 (75.0)	8/11 (72.7)	0.893	0.640¹
Re-treatment for residual stones⁴	2/40 (5.0)	6/48 (12.5)	1/11 (9.1)	N/A³	0.412
Final stone clearance⁴	34/40 (85.0)	39/48 (81.3)	8/11 (72.7)	0.894	0.640¹
Stone recurrence⁵	2/34 (5.9)	2/39 (5.1)	0/8 (0.0)	N/A³	1.000
Late complications⁴	1/40 (2.5)	3/48 (6.3)	1/11 (9.1)	N/A³	0.411
Late major complications⁴	0/40 (0.0)	1/48 (2.1)	0/11 (0.0)	N/A³	1.000
Secondary ICC⁴	1/40 (2.5)	0/48 (0.0)	0/11 (0.0)	N/A³	0.515
Late death due to complications or ICC⁴	1/40 (2.5)	0/48 (0.0)	0/11 (0.0)	N/A³	0.515

¹χ² test was used.

²Kruskal-Wallis test was used.

³No χ² value was reported for Fisher's exact test.

⁴Two patients in the laparoscopic left hemihepatectomy subgroup had no postoperative imaging data and were excluded.

⁵Six patients in the reoperative laparoscopic left lateral sectionectomy subgroup, 11 in the reoperative laparoscopic left hemihepatectomy subgroup, and 3 in ther laparoscopic complex hepatectomy subgroup were excluded due to no follow-up data and residual stone.

⁶compared with the reoperative laparoscopic left lateral sectionectomy subgroup, P < 0.05.

⁷compared with the reoperative laparoscopic left hemihepatectomy subgroup, P < 0.05.

Data are presented as number/total number (percentage) of patients unless otherwise indicated. IQR: Interquartile range; ICC: Intrahepatic cholangiocarcinoma; N/A: Not applicable.

Table 3 Clinical outcomes of the two subgroups of reoperative left lateral sectionectomy

Clinical outcomes	Reoperative open left lateral sectionectomy (n = 40)	Reoperative laparoscopic left lateral sectionectomy (n = 40)	χ²/Z value	P value
Selective hepatic blood flow occlusion	5/40 (12.5)	8/40 (20.0)	0.827	0.363¹
Operation duration, median (IQR), minute	200.0 (180.0-240.0)	240.0 (196.3-322.5)	-3.073	0.002²
Blood loss, median (IQR), mL	200.0 (81.3-300.0)	200.0 (75.0-281.2)	-0.743	0.457²
Blood transfusion	12/40 (30.0)	4/40 (10.0)	5.000	0.025¹
Conversion to open surgery	-	3/40 (7.5)	-	-
Postoperative intensive care unit stay	5/40 (12.5)	5/40 (12.5)	0.000	1.000¹
Postoperative hospital stay, median (IQR), days	10.0 (8.0-17.0)	8.0 (6.0-10.0)	-3.332	0.001²
Early complications within 90 days	16/40 (40.0)	17/40 (42.5)	0.052	0.820¹
Major complications within 90 days	1/40 (2.5)	2/40 (5.0)	N/A³	1.000
Reinterventions within 90 days	1/40 (2.5)	2/40 (5.0)	N/A³	1.000
Readmission within 90 days	5/40 (12.5)	6/40 (15.0)	0.105	0.745¹
90-day mortality	0/40 (0.0)	0/40 (0.0)	-	-
Initial stone clearance rate⁴	29/39 (74.4)	33/40 (82.5)	0.775	0.379¹
Re-treatment of residual stones⁴	4/39 (10.3)	2/40 (5.0)	N/A³	0.432
Final stone clearance rate⁴	32/39 (85.0)	34/40 (85.0)	0.125	0.724¹
Stone recurrence⁵	9/32(28.1 )	2/34 (5.9)	5.872	0.015¹
Late complications⁴	1/39 (2.6)	1/40 (2.5)	N/A³	1.000
Late major complications⁴	1/39 (2.6)	0/40 (0.0)	N/A³	0.494
Secondary ICC⁴	4/39 (10.3)	1/40 (2.5)	N/A³	0.201
Late death due to complications or ICC⁴	4/39 (10.3)	1/40 (2.5)	N/A³	0.201

¹χ² test was used.

²Mann-Whitney U test was used.

³No χ² value was reported for Fisher's exact test.

⁴One patients in the reoperative open left lateral sectionectomy group had no postoperative imaging and was excluded.

⁵Seven patients in the reoperative open left lateral sectionectomy group and 6 in the reoperative laparoscopic left lateral sectionectomy group were further excluded due to residual stone.

Data are presented as number/total number (percentage) of patients unless otherwise indicated. IQR: Interquartile range; ICC: Intrahepatic cholangiocarcinoma; N/A: Not applicable.

Table 4 Clinical outcomes of the two subgroups of reoperative left hemihepatectomy

Clinical outcomes	Reoperative open left hemihepatectomy (n = 33)	Reoperative laparoscopic left hemihepatectomy (n = 50)	χ²/t/Z value	P value
Selective hepatic blood flow occlusion	29/33 (87.9)	47/50 (94.0)	0.956	0.326¹
Operation duration, mean (SD), minute	244.7 (84.7)	318.9 (88.5)	-3.800	0.000²
Blood loss, median (IQR), mL	235.7 (150.0-400.0)	200.0 (100.0-400.0)	-1.411	0.158³
Blood transfusion	13/33 (39.4)	11/50 (22.0)	2.926	0.087¹
Conversion to open surgery	-	8/50 (16.0)	-	-
Postoperative intensive care unit stay	5/33 (15.2)	10/50 (20.0)	0.316	0.574¹
Postoperative hospital stay, median (IQR), days	13.0 (8.0-21.0)	8.0 (7.0-12.3)	-3.237	0.001³
Early complications within 90 days	21/33 (63.6)	27/50 (54.0)	0.757	0.384¹
Major complications within 90 days	1/33 (3.0)	3/50 (6.0)	N/A⁴	1.000
Reinterventions within 90 days	1/33 (3.0)	3/50 (6.0)	N/A⁴	1.000
Readmission within 90 days	6/33 (18.2)	10/50 (20.0)	0.042	0.837¹
90-day mortality	0/33 (0.0)	0/50 (0.0)	-	-
Initial stone clearance rate⁵	25/32 (78.1)	36/48 (75.0)	0.104	0.748¹
Re-treatment of residual stones⁵	4/32 (12.5)	6/48 (12.5)	N/A³	1.000
Final stone clearance rate⁵	26/32 (81.3)	39/48 (81.3)	0.000	1.000¹
Stone recurrence⁶	8/26(30.8 )	2/39 (5.1)	N/A⁴	0.011
Late complications⁵	4/32 (12.5)	3/48 (6.3)	N/A⁴	0.429
Late major complications⁵	2/32 (6.3)	1/48 (2.1)	N/A⁴	0.561
Secondary ICC⁵	0/32 (0.0)	0/48 (0.0)	-	-
Late death due to complications or ICC⁵	1/32 (3.1)	0/48 (0.0)	N/A⁴	0.400

¹χ² test was used.

²Student t-test was used.

³Mann-Whitney U test was used.

⁴No χ² value was reported for Fisher's exact test.

⁵One patients in the reoperative open left hemihepatectomy group and 2 in the reoperative laparoscopic left hemihepatectomy group had no postoperative imaging and were excluded.

⁶Six patients in the reoperative open left hemihepatectomy group and 9 in the reoperative laparoscopic left hemihepatectomy group were further excluded due to residual stone.

Data are presented as number/total number (percentage) of patients unless otherwise indicated. IQR: Interquartile range; ICC: Intrahepatic cholangiocarcinoma; N/A: Not applicable.

Citation: Zhang WJ, Chen G, Dai DF, Chen XP. Not all reoperative laparoscopic liver resection procedures are feasible for hepatolithiasis patients with a history of biliary surgery. World J Hepatol 2025; 17(5): 105890
URL: https://www.wjgnet.com/1948-5182/full/v17/i5/105890.htm
DOI: https://dx.doi.org/10.4254/wjh.v17.i5.105890