Laparoscopy versus open left lateral segmentectomy for recurrent pyogenic cholangitis

Abstract

This study not only confirmed the feasibility of hand-assisted laparoscopic segmentectomy for recurrent pyogenic cholangitis, but also showed that this treatment approach is associated with less pain and shorter hospital stay. However, hand-assisted laparoscopic segmentectomy is a lengthier operation and technically more challenging. Nevertheless, the authors believe that with more experience and further improvement of ancillary technology, this procedure can become a standard treatment for recurrent pyogenic cholangitis in selected cases.

Laparoscopic left lateral liver resection should be a standard operation

“…1 and 2, six studies [4][5][6][7][8][9] compared the operative time between the two groups and found that the operative time was 48.07 min (95% CI, 30.93-65.21) shorter in the open group than in the laparoscopic group. This difference was significant (p \ 0.001) and not associated with significant heterogeneity between the studies (p = 0.34).…”

“…5 and 6, four studies [5,6,9,10] documented the duration of hospital stay in each group. The hospital stay in the laparoscopic group was 4.52 days (95% CI, -8.03 to -1.02) shorter than in the open group.…”

“…Five studies were retrospective (Table 1) [4,[6][7][8]10], and in the remaining two studies, the prospective data of laparoscopic group were matched with the retrospective data of the open group [5,9]. Two studies contained resection of only benign lesions [5,6], whereas only one study contained solely malignant lesions [10].…”

“…Observational studies have shown the increased efficiency and safety of the laparoscopic left lateral sectionectomy. Some studies have directly compared laparoscopic and open left lateral sectionectomies [4][5][6]. However, no randomized controlled trial or metaanalysis has compared these two types of hepatic resection.…”

Recurrent pyogenic cholangitis due to chronic infestation with Clonorchis sinensis (2006: 8b)

“…Definitive treatment usually involves resection of the stone-harbouring segments. Recent studies have shown that hand-assisted laparoscopic segmentectomy is not only feasible in this condition, but is also associated with less post-operative pain and a shorter in-patient hospital stay [12].…”