Biliary tract exploration through a common bile duct incision or left hepatic duct stump in laparoscopic left hemihepatectomy for left side hepatolithiasis: which is better?

Abstract

Laparoscopic left hemihepatectomy (LLH) followed by biliary tract exploration is used to treat left-sided hepatolithiasis (LSH). The purpose of this study was to compare the efficacy of 2 methods of biliary tract exploration in LLH:biliary tract exploration through a common bile duct (CBD) incision (with T-tube drainage) or through the left hepatic duct (LHD) stump (without T-tube drainage).LSH patients (113 patients) were recruited retrospectively in our hospital from December 2008 to January 2016. To compare different methods of biliary tract exploration during LLH, the patients were divided into 2 groups: 41 patients underwent biliary tract exploration through the LHD stump (LHD group), and 72 patients underwent biliary tract exploration through a CBD incision (CBD group). Baseline characteristics, surgical outcomes, surgery-related complications, postoperative hospital stay (PHS) and long-term results were compared between the 2 groups.There was no unplanned reoperation in the 2 groups. One patient in the CBD group had a residual stone, which was removed by choledochoscopy 2 months postoperation. Two patients in the LHD group and 3 patients in the CBD group had bile leakage and were cured with abdominal drainage. There were no significant differences in the total operation time, incidence of residual stones and bile leakage between the 2 groups (P > .05). The PHS and the incidence of hypokalemia or hyponatremia in the LHD group were significantly lower than those in the CBD group (P < .05). T-tube-related complications occurred in 13.9% (10/72) of the CBD patients. The mean follow-up period was 37.2 ± 13.8 months. There were no significant differences in the incidence of recurrence stones or cholangitis (P > .05) between the 2 groups.Exploration of the biliary tract through the LHD stump without T-tube drainage is safe with satisfactory short- and long-term results for selected LSH patients.

Biliary tract exploration via left hepatic duct stump versus the common bile duct incision in left‐sided hepatolithiasis: a meta‐analysis

“…2a, Table 2). On the other hand, pooled results for three studies 4,7,8 showed a similar trend in estimated blood loss between LHD and CBD approach (SMD = 0.15; 95% CI: −0.10, 0.41; P = 0.23; Fig. 2b).…”

“…A total of 849 studies were eliminated following removal of duplicates. The selected 47 articles were subjected to full‐text analysis, resulting in five that were finally included in this meta‐analysis 4,7,8,13,14 (Fig. 1).…”

“…To reduce the potential risks of choledochotomy‐derived bile leakage or stenosis, intra‐operative bile duct exploration via left hepatic duct (LHD) stump without a choledochotomy has been proposed 6 . In fact, several studies have compared the feasibility and effectiveness of LHD and CBD for intra‐operative biliary tract exploration in left‐side hepatolithiasis 7,8 . For example, Hu et al 7 .…”

Long-term efficacy and advantages of minimally invasive hepatectomy for hepatolithiasis

“…Hepatolithiasis is mainly caused by bacterial infection, parasites, bile stasis, anatomical variation, dietary structure, and genetics, with the pathological changes of hepatobiliary cholestasis, acute and chronic inflammation, inflammatory stenosis, and proximal dilation. [ 14 , 15 ] The accumulating stones in dilated bile ducts could further aggravate the obstruction, leading to repeated inflammation, abscesses, systemic sepsis, and even biliary ulceration. Hepatectomy is the main method to remove stones, correct bile duct stenosis, smooth bile duct drainage, and prevent disease recurrence.…”

Severe Persistent Hyponatremia: A Rare Presentation of Biliary Fluid Loss

“…Reported side effects of such tubes include bile loss, infection at the site of the tube, and displacement of the tube. 9 It has been reported that tube drainage after common duct exploration is associated with high-volume biliary output. 6 This patient had excessive bile loss through their tube, and clamping of the tube paired with treatment administration allowed for resolution of the patient's hyponatremia.…”