Laparoscopic left hemihepatectomy for left intrahepatic duct stones

Abstract

Purpose: The feasibility of laparoscopic left hemihepatectomy for the management of intrahepatic duct (IHD) stones was evaluated.

Methods: The clinical data of 26 consecutive patients who underwent total laparoscopic left hemihepatectomy for IHD stones at Gyeongsang National University Hospital between January 2009 and June 2011 were reviewed retrospectively.

Results: The mean operation time was 312.1 ± 63.4 minutes and the mean postoperative hospital stay was 11.8 ± 5.0 days. There were 2 cases of postoperative bile leakage and 3 cases of intra-abdominal fluid collection, which were successfully managed conservatively. Remnant stones were detected in 2 patients. The initial success rate of stone clearance was 92.3% (24 of 26). The remnant stones were located in the common bile duct in both cases and were removed by endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. Therefore, the final success rate of stone clearance was 100% (26 of 26). During a mean follow-up of 22 months (range, 7 to 36 months), there was no patient with recurrent stone.

Conclusion: Laparoscopic surgery could be an effective treatment modality for the management of IHD stones in select patients.

Keywords: Hepatectomy; Laparoscopy.

Fig. 1

Position of trocars. The operator used 3rd and 4th trocar on the right side of the patient and the assistant used 2 trocars on the left side.

Fig. 2

Procedures of laparoscopic left hemihepatectomy. (A) Hepatic artery had been dissected and ligated by hem-O-lock. (B) Left portal vein was dissected and clamped. (C) Intraoperative choledochoscopy was performed to confirm residual stone. (D) The duct was closed with intracorporeal sutures.