To investigate the surgical procedure, characteristics and clinical efficacy of anatomical hepatectomy with Glissonian approach for hepatolithiasis.

Clinical data of 37 patients with hepatolithiasis who underwent anatomical hepatectomy with Glissonian approach in the First People's Hospital of Shunde Affiliated to Southern Medical University between May 2009 and July 2014 were retrospectively analyzed. Among the patients, 9 were males and 28 were females with the age ranging from 27 to 83 years old and the median of 53 years old. According to the hepatolithiasis classification of Biliary Tract Surgery Group of Surgery Branch of Chinese Medical Association (2007), 27 cases were with typeⅠhepatolithiasis and 10 cases were with type Ⅱ hepatolithiasis. The informed consents of all patients were obtained and the local ethical committee approval was received. Anatomical hepatectomy with Glissonian approach and intraoperative cholangioscopic lithotomy were performed on the patients. The conditions during operation, postoperative complications of bile leakage, liver failure, abdominal infection, and stone clearance rate were observed.

All patients completed the operations successfully. Four cases underwent resection of single segment, 1 of segment Ⅲ and part of segment Ⅷ, 10 of left lateral lobe, 13 of left lobe, 1 of segment Ⅳ and Ⅴ, 1 of right anterior lobe, 4 of right posterior lobe, 2 of right lobe, and 1 of left lateral lobe and right posterior lobe. The median length of operation was 300(140-450) min and the intraoperative blood loss was 350(10-800) ml. No death was observed during perioperative period. And no bile leakage, liver failure or abdominal infection was observed after operation. The stone clearance rate of patients with typeⅠand type Ⅱ hepatolithiasis was respectively 93%(25/27) and 6/10, and the overall stone clearance rate was 84% (31/37).

Anatomical hepatectomy with Glissonian approach has the advantages of relatively easy dissection of intrahepatic ducts, low possibility of accidental injury to biliary ducts, easy discrimination of liver resection border, easy protection of normal caudate lobe and clear intraoperative dissection. Thus, it is a safe and practical liver resection method for hepatolithiasis.