To investigate surgical treatment and clinical efficacy of biliary tract variations complicated with complex hepatolithiasis, and perform literature review.

Clinical data of a patient diagnsed with biliary duct variations and complex hepatolithiasis who underwent surgical treatment in the Affiliated Hospital of North Sichuan Medical College in April, 2024 were retrospectively analyzed. A 36-year-old female patient was admitted due to "epigastric pain and discomfort for more than 1 month". AST level was 88 U/L, ALT 217 U/L, TB 27.8 μmol/L and DB 11.2 μmol/L, respectively. MRI and MRCP of the upper abdomen showed stones in the upper and middle common bile duct, hilar bile duct and left and right intrahepatic bile ducts complicated with bile duct dilatation and cholangitis. Biliary duct variations: the right anterior lobe and the left hepatic duct merged into the common bile duct in parallel, and the right posterior lobe bile duct dilated and merged into the common bile duct at the lower posterior end; and cholestasis. Preliminary diagnosis: intrahepatic and extrahepatic bile duct stones complicated with cholangitis; anatomical biliary variants, Couinaud segement Ⅳ; hepatic insufficiency; and cholestasis. The informed consent of this patient was obtained and the local ethical committee approval was received.

After comprehensive evaluation before operation, laparoscopic right hemihepatectomy, cholecystectomy, choledochoscopic exploration and lithotomy, bile duct repair and plasty combined with T tube drainage were performed under general anesthesia on April 10, 2024. The operation time was 185 min, intraoperative bleeding was estimated 100 ml, and no blood transfusion was delivered intraoperatively. The patient was discharged at postoperative 10 d. Pathological examination showed no sign of canceration. Pigment deposition was seen in partial cells of the right lobe, fibrous hyperplasia in portal area and surrounding area, lymphocyte infiltration and intrahepatic bile duct dilatation were also found. The patient was followed up by outpatient and telephone after discharge. T-tube cholangiography at postoperative 1 month confirmed no residual stones and T tube was removed subsequently. Postoperative follow-up was conducted to monitor the condition and prevent the recurrence. No recurrence has been reported as of the submission date.

Comprehensive preoperative evaluation, careful intraoperative operation and attentive postoperative management can effectively reduce the risk of anatomic variations of bile duct and vessels during laparoscopic hepatectomy in the treatment of hepatolithiasis, and enhance surgical safety and efficacy.