Laparoscopic versus open secondary hepatectomy treating postoperative regional recurrent hepatolithiasis: a multicenter real-world study.

BACKGROUND

Hepatectomy is the primary treatment for regional hepatolithiasis, but recurrence rates range from 10 to 20%, often necessitating repeat surgery. Although laparoscopic hepatectomy has been widely adopted for recurrent hepatocellular carcinoma, its use in recurrent hepatolithiasis remains limited due to technical challenges, including severe adhesions, anatomical distortions, and increased risks of complications. No large-scale study has compared laparoscopic and open repeat hepatectomy for recurrent regional hepatolithiasis.

METHODS

This multicenter retrospective study included 913 patients from nine high-volume centers in southeastern China between May 2014 and 2023. Patients were divided into laparoscopic (n = 338) and open surgery (n = 575) groups. Propensity score matching was used to balance baseline characteristics. Primary outcomes included stone clearance rates and textbook outcomes (TO), a composite measure assessing final stone clearance, hospital stay, bile leakage, major complications, and 30-day readmissions. Secondary outcomes included perioperative metrics, complication rates, and recurrence-free survival.

RESULTS

After PSM, laparoscopic surgery demonstrated comparable immediate stone clearance rates (81.07% vs. 78.40%, p = 0.386) but significantly better TO rates (61.54% vs. 46.09%, p < 0.001) to the open surgery group. The laparoscopic group had reduced blood loss (p = 0.016), shorter hospital stays (p < 0.001), faster recovery of bowel function (p < 0.001), and fewer major complications (13.91% vs. 23.08%, p = 0.003). Recurrence rates were similar between groups during a median follow-up of 36 months. Hepatic lobe atrophy and biliary strictures were identified as independent risk factors for reduced stone clearance.

CONCLUSION

Laparoscopic repeat hepatectomy offers comparable stone clearance rates to open surgery while providing significant advantages in perioperative outcomes, including reduced complications and faster recovery. These findings suggest laparoscopic surgery is a feasible and effective option for recurrent regional hepatolithiasis.