Application experience of left hemihepatectomy using the left Glissonean pedicle transverse method combined with cholangiolithotomy via the anterior bile duct wall of the LHD to treat left hepatolithiasis

This study aimed to investigate the clinical value of left hemihepatectomy performed using the left Glissonean pedicle transverse approach combined with cholangiolithotomy via the anterior bile duct wall of the left hepatic duct (LHD) for the treatment of left hepatolithiasis. A retrospective analysis was conducted on the clinical data of 40 patients who underwent laparoscopic anatomic left hemihepatectomy combined with cholangiolithotomy via the LHD for the treatment of left hepatolithiasis between October 2020 and October 2023. The patients were divided into two groups based on the procedure they received: the experimental group, which underwent laparoscopic left hemihepatectomy using the left Glissonean pedicle transverse approach combined with cholangiolithotomy via the anterior wall of the LHD, and the control group, which underwent laparoscopic left hemihepatectomy combined with cholangiolithotomy via dissection of the LHD. The clinical feasibility and efficacy of this surgical strategy were evaluated by comparing intraoperative blood loss, operative duration, drainage tube retention time, complication rate, postoperative recovery duration, residual stone rate, and stone recurrence rate between the two groups. Statistical analysis showed that there was no statistically difference between the two groups in terms of age, gender, body mass index (BMI), and prior biliary surgery rate (P > 0.05). Patients in the experimental group exhibited lower intraoperative blood loss (136.67 ± 69.35 vs. 195.00 ± 95.01 mL), shorter operative duration (268.67 ± 49.41 vs. 305.00 ± 55.38 min), and shorter postoperative recovery time (9.67 ± 2.69 vs. 11.97 ± 3.41 days), all of which were better than those in the control group (P < 0.05). However, no statistically differences were observed between the two groups regarding drainage tube retention time, complication rate, postoperative residual stone rate, or stone recurrence rate (P > 0.05). Left hemihepatectomy using the left Glissonean transverse approach combined with cholangiolithotomy via the anterior wall of the LHD provides a replaceable surgical strategy for the treatment of left hepatolithiasis. This technique simplifies the operative procedure and offers improved safety and efficacy compared to conventional methods. Moreover, it is particularly suitable for patients who have undergone multiple biliary surgeries and in whom hilar dissection is technically challenging.