To evaluate the strategy and efficacy of laparoscopic hepatectomy in the classified treatment of hepatolithiasis.

Clinical data of 81 patients with hepatolithiasis who underwent laparoscopic hepatectomy in the Affiliated Hospital of North Sichuan Medical College from January 2016 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 19 patients were male and 62 female, aged from 30 to 83 years with a median age of 53 years. According to the classification of hepatolithiasis, 61 cases were classified as type Ⅰ and 20 cases type Ⅱb. The atrophic liver lobes or segments in patients with type Ⅰ hepatolithiasis were resected. For patients with type Ⅱb hepatolithiasis, the limited nonfunctional liver lobes or segments were resected. The incidence of complication during and after operation was observed.

All patients completed laparoscopic hepatectomy successfully. Among them, 11 patients underwent left lateral lobectomy,57 cases left hemihepatectomy, 8 cases right hemihepatectomy, 1 case right posterior lobectomy, 1 case left lateral lobectomy combined with right anterior lobectomy, and 3 cases of left lateral lobectomy combined with the upper right posterior lobectomy. The mean operation time was (220±96) min, the intraoperative blood loss was (424±120) ml, the off-bed time after operation was (2.8±1.1) d, the postoperative eating time was (1.4±0.7) d, and the length of postoperative hospital stay was (14±6) d. Residual stones occurred in 2 cases. Intraoperative gastrointestinal injury occurred in 4 cases. Postoperatively, 12 cases developed pulmonary infection, 20 cases of pleural effusion, 9 cases of hepatic cross-section effusion including 7 cases complicated with infection, 5 cases of bile leakage, 2 cases of incisional infection and 2 cases of gastrointestinal dysfunction. All complications were cured after conservative treatments.

Individual therapeutic strategy should be adopted according to the classification and distribution of hepatolithiasis. Laparoscopic hepatectomy is a safe and efficacious treatment for type Ⅰ and type Ⅱb hepatolithiasis, which can achieve satisfactory clinical efficacy.