Laparoscopic Glissonian pedicle versus hilar dissection approach hemihepatectomy: A prospective, randomized controlled trial.

BACKGROUND/PURPOSE: This over 7-year case study is the first to compare the results of laparoscopic Glissonian pedicle approach hemihepatectomy (LGAH) and laparoscopic hilar dissection approach hemihepatectomy (LHAH) in a randomized controlled trial (RCT). METHODS: Patients who had undergone laparoscopic hemihepatectomy, either LGAH or LHAH, between March 2012 and December 2019 at our center were prospectively enrolled and assigned to the LGAH or LHAH group. Both groups were stratified and compared, and the preoperative and follow-up outcomes were analyzed. The primary endpoint was total operative time. RESULTS: The groups were equally matched for age, sex, HBsAg, Child-Pugh class, benign disease, malignancy, liver cirrhosis, tumor diameter and type of resection. Ninety-six patients had undergone LGAH and 94 had undergone LHAH. No preoperative death occurred in the two groups. LGAH did not enhance the postoperative overall complication rates (P = .465) or intraoperative blood loss (P = .535) compared with LHAH. However, the overall operative time (P = .014) and hilar dissection time (P = .000) were significantly shorter in the LGAH group than in the LHAH group. No significant differences were found between the groups regarding the 1-year (P = .384), 3-year (P = .332), and 5-year overall survival rates (P = .662) or 1-year (P = .856), 3-year (P = .348), and 5-year disease-free survival rates (P = .573). CONCLUSIONS: LGAH and LHAH are both effective procedures for treating the hilar structures in selected patients. LGAH has advantages over LHAH in reducing total operation time under the condition where both procedures can be used. LGAH for selected patients is worthy of promotion owing to its simplicity and convenience. REGISTRATION NUMBER: NCT01567631 (http://www. CLINICALTRIALS: gov).

Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments.

BACKGROUND: Traditional open liver resection remains the classic procedure for hepatocellular carcinoma (HCC) located in the posterosuperior segments of the liver (segments I, IVa, VII, and VIII). This study compared the perioperative and oncologic results for laparoscopic versus open liver resection of HCC located in the posterosuperior segments, especially in patients with cirrhosis. METHODS: This study included 41 patients who underwent laparoscopic liver resection (LLR) and 86 who underwent open liver resection (OLR) for HCC in the posterosuperior segments between January 1, 2010, and December 31, 2012. There perioperative course and oncologic outcomes were retrospectively evaluated. RESULTS: There were no significant differences between the LLR and OLR groups in length of operation (242.41 ± 73.69 vs. 235.38 ± 65.80 min), transfusion rate (7.3 vs. 14.0 %), R0 resection rate (100 vs. 97.7 %), or tumor size (4.22 ± 2.05 vs. 4.30 ± 1.49 cm). In contrast, postoperative hospital stay (9.44 ± 2.72 vs. 14.53 ± 6.03 days) was significantly shorter, and postoperative complication rates (17.1 vs. 37.2 %) and intraoperative blood loss (272.20 ± 170.86 vs. 450.12 ± 344.70 mL) significantly lower in the LLR than in the OLR group. In addition, there was no significant difference between the two groups (LLR vs. OLR) regarding 1-year overall survival rate (95.1 vs. 89.5 %), 3-year overall survival rate (78 vs. 76.7 %,), 1-year disease-free survival rate (87.8 vs. 82.6 %,), and 3-year disease-free survival rate (70.7 vs. 68.6 %). CONCLUSIONS: LLR for selected patients with HCC in the posterosuperior segments may offer the same oncologic outcomes as conventional procedures, while being associated with such advantages as lower blood loss, fewer postoperative complications, and shorter hospital stay.

Therapeutic effects of laparoscopic splenectomy and esophagogastric devascularization on liver cirrhosis and portal hypertension in 204 cases.

OBJECTIVE: To investigate the effects and technical points of laparoscopic splenectomy and esophagogastric devascularization (LS+ED) for portal hypertension (PH) due to liver cirrhosis. SUBJECTS AND METHODS: In total, 204 PH patients who underwent LS+ED from January 2008 to April 2013 in the Southwest Hospital of the Third Military Medical University were enrolled in this study. We retrospectively analyzed the clinical data and the key technical points and compared the results with other researchers. RESULTS: LS+ED was successfully carried out on 188 patients. The mean duration of surgery was 232±59 minutes, the mean intraoperative blood loss was 189±137 mL, the rate of blood transfusion was 19.6% (40/204), and no deaths occurred during surgery. The mean postoperative interval to passing of flatus was 3.5±0.9 days, and the mean postoperative hospital stay was 8.7±2.2 days. Operative complications occurred in 100 patients, of whom 78 had portal vein system thrombosis (PVST). During a postoperative follow-up period of 2-65 months, 15 cases were lost to follow-up, esophagogastric variceal bleeding re-occurred in 7 patients, encephalopathy occurred in 2 patients, and secondary liver cancer occurred in 3 patients. Five patients died during this period. CONCLUSIONS: The technical points of LS+ED include a combined surgical approach, a reasonable surgical procedure, and an appropriate laparoscopic operating plane. LS+ED is a safe and effective treatment for minimal trauma and rapid recovery. PVST is a common and potentially life-threatening complication after LS+ED, and anticoagulation therapy should be given early.

Laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis: an experience of 116 cases.

BACKGROUND: An increasing number of patients with hepatolithiasis were diagnosed at an early stage in China. Laparoscopic surgery has introduced new methods of treating this condition. AIM: To investigate the patient selection, operative technique, and efficacy of laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis. PATIENTS AND METHODS: The clinical data of 116 patients who underwent laparoscopic hepatectomy (laparoscopic group) and 78 patients who underwent open hepatectomy (open group) for hepatolithiasis were retrospectively analyzed, and were compared with the recent reports. RESULTS: The laparoscopic group had a longer duration of operation (323.3 ± 103.0 min vs. 272.8 ± 66.8 min, p<0.05) and shorter postoperative hospital stay (13.1 ± 5.6 days vs. 16.5 ± 8.4 days, p<0.05) than the open group. There were no significant differences between the two groups in intraoperative blood loss or transfusion rate, postoperative complications, calculus clearance, calculus recurrence, or recurrent cholangitis (p>0.05 for all). Efficacy in the laparoscopic group was similar to that in other recently reported studies. CONCLUSIONS: Laparoscopic hepatectomy with bile duct exploration is safe and feasible for early stage localized hepatolithiasis, with an efficacy similar to that of open surgery. Anatomic hepatectomy is important for achieving good therapeutic outcomes.

The safety and feasibility of reoperation for the treatment of hepatolithiasis by laparoscopic approach.

BACKGROUND: Hepatolithiasis removal is associated with high rates of postoperative residual and recurrence, which in some cases may require multiple surgeries. The progress and development of laparoscopic techniques introduced a new way of treating hepatolithiasis. However, the selection criteria for laparoscopic hepatolithiasis surgery, particularly among patients with a history of biliary surgery, remain undetermined. This study aimed to evaluate the safety, feasibility, and efficacy of reoperation for the treatment of hepatolithiasis via a laparoscopic approach. METHODS: A retrospective analysis of the perioperative course and outcomes was performed on 90 patients who underwent laparoscopic procedures for hepatolithiasis between January 1, 2008, and December 31, 2012. Thirty-eight patients had previous biliary tract operative procedures (PB group) and 52 patients had no previous biliary tract procedures (NPB). RESULTS: There was no significant difference in operative time (342.3 ± 101.0 vs. 334.1 ± 102.7 min), intraoperative blood loss (561.2 ± 458.8 vs. 546.3 ± 570.5 ml), intraoperative transfusion (15.8 vs. 19.2 %), postoperative hospitalization (12.6 ± 4.2 vs. 13.4 % ± 6.3 days), postoperative complications (18.4 vs. 23.1 %), conversion to open laparotomy (10.5 vs. 9.6 %), or intraoperative stone clearance rate (94.7 vs. 90.4 %). There was also no significant difference in stone recurrence (7.9 vs. 11.5 %) and recurrent cholangitis (5.3 vs. 13.5 %) at a mean of 19 months of follow-up (range, 3-51 months) for PB patients compared to NPB patients. The final stone clearance rate was 100 % in both groups. CONCLUSIONS: Reoperation for hepatolithiasis by laparoscopic approach is safe and feasible for selected patients who have undergone previous biliary operations.