Background : Hepatolithiasis is a still a common disease in Vietnam and many countries in Asia with high rates of residual stones and recurrence after treatment. Treatment of hepatolithiasis requires a careful selection and combination between surgical, endoscopic and interventional treatment. The role of laparoscopy, especially in hepatectomy for hepatolithiasis remains unclear and controversial due to technical difficulties.

Methods : Between October 2020 and April 2023, 35 consecutive patients with hepatolithiasis undergoing laparoscopic hepatectomy were enrolled. The general characteristics, intraoperative, and postoperative data were analyzed.

Results : Mean age was 55.9 ± 12.6 years; female/male ratio was 2.3; 14.3% patients had previous biliary surgery. Acute cholangitis occurred in 68.6% patients. 28.6% patients had both intra- and extrahepatic duct stones. Left lateral sectionectomy was performed in (25 cases), followed by left hepatectomy (5 cases), right posterior sectionectomy (3 cases), right hepatectomy (2 cases). 46.7% patients underwent common bile duct exploration. Cholangioscopic exploration with/without laser lithotripsy was used in 37.1%. The median surgery time is 170 (120 - 200) minutes. Intraoperative blood transfusion was required in only 3 cases (8.5%). Mean time to bowel movement was 2.3 ± 0.7 days. Mean post-operative hospital stay was 7.7 ± 2.2 days. Post-operative complications occurred in 14.3%; including wound infection 8.5%; residual abscess 2.9%, and bile leak 2.9%. Complete stone clearance rate was 91.2%.

Conclusions : Laparoscopic liver resection, especially left lobectomy, is safe and effective treatment for patients with hepatolithiasis.