Advantages of laparoscopic left hemihepatectomy: A meta-analysis

Abstract

Background: Laparoscopic left hemihepatectomy (LLH) has been widely accepted as a minimally invasive alternative to open liver surgery. We assessed the benefits and drawbacks of LLH compared with open left hemihepatectomy (OLH) using meta-analysis.

Methods: Relevant literature was retrieved using PubMed, Embase, Cochrane, and Ovid Medline databases. Multiple parameters of efficacy and safety were compared between the treatment groups. Results are expressed as odds ratio (OD) or mean difference (MD) with 95% confidence interval (95% CI) for fixed- and random-effects models.

Results: The meta-analysis included 13 trials involving 1163 patients. Compared with OLH, LLH significantly reduced intraoperative blood loss (MD, -91.01; 95% CI, -139.12 to -42.89; P = .0002), transfusion requirement (OR, 0.24; 95% CI, 0.11-0.54; P = .0004), time to oral intake (MD, -0.80; 95% CI, -1.27 to -0.33; P = .0008), and hospital stay (MD, -3.94; 95% CI, -4.85 to -3.03; P < .0001). However, operative time; complications rate; and postoperative alanine transferase, albumin, and total bilirubin levels did not differ significantly between the 2 surgical groups (P > .05). For hepatolithiasis treatment, there were no significant differences in operative time, residual stones, stone recurrence, and complications rate between the groups (P > .05), but LLH resulted in lower incisional infection rate (OR, 0.44; 95% CI, 0.22-0.89; P = .02) than OLH. The LLH group demonstrated higher bile leakage rate (OR, 1.79; 95% CI, 1.14-2.81; P = .01) and incurred greater hospital costs (MD, 618.56; 95% CI, 154.47-1082.64; P = .009).

Conclusions: LLH has multiple advantages over OLH and should thus be considered as the first choice for left hemihepatectomy.

Figure 1

Flow diagram of study selection.

Figure 2

Forest plots comparing the intraoperative parameters operative time (A), blood loss (B), and blood transfusion (C) between the entire LLH and OLH groups. LLH = laparoscopic left hemihepatectomy, OLH = open left hemihepatectomy.

Figure 3

Forest plots comparing postoperative parameters time to oral intake (A), length of hospital stay (B), hospitalization charges (C), and complications (D) between the entire LLH and OLH treatment groups. LLH = laparoscopic left hemihepatectomy, OLH = open left hemihepatectomy.

Figure 4

Forest plots comparing the hepatolithiasis outcomes operative time (A), blood loss (B), blood transfusion (C), and length of hospital stay (D).

Figure 5

Forest plots comparing the hepatolithiasis outcomes complications rate (A), residual stones (B), and stone recurrence (C).

Figure 6

Forest plots comparing hepatolithiasis complications bile leakage (A), incisional infection (B), intra-abdominal fluid collection (C), abdominal infection (D), and pneumonia (E).

Figure 6 (Continued)

Forest plots comparing hepatolithiasis complications bile leakage (A), incisional infection (B), intra-abdominal fluid collection (C), abdominal infection (D), and pneumonia (E).