Twenty one cases of hepatocholelithiasis treated through hepatic round ligament approach for hepaticojejunostomy is reported. Of them 5 were introgenic injury to the biliary tract， 8 were left hepatolithiasis (7 complicated with bile duct stricture), 2 were intrahepatic sandy stone with acute suppurative cholangeitis, and 3 were residual stone in left hepatic duct with cystlike dilatation after T-tube drainage; while traumatic injury to the biliary passages, previous multiple biliary tract operations and left hepatic duct stone with acute hemorrhage were present in one of case individually 75.9% each. The ages of the patients were between 32 to 50 years. Clinical follw-up in this series was satisfactory. The authors consider that this approach gives good exposure with little injury to the liver and no liver resection needed. The indication for this approach mode of anastomosis and some operative details are discussed.
ObjectiveTo investigate the effect of the round ligament fissure approach in re-hepatectomy.MethodsA total of 40 patients with recurrence of hepatocellular carcinoma (HCC) who underwent re-hepatectomy in the Department of Hepatopancreatobiliary Surgery of Leshan People’s Hospital from June 2017 to August 2020 were collected and divided into two groups according to different surgical approaches: study group (transhepatic round ligament fissure approach) and control group (conventional surgical approach), 20 cases in each group. The perioperative general indicators, peripheral blood laboratory indicators, and complications of the two groups were compared.ResultsCompared with the control group, the operation time, postoperative drainage tube removal time, and postoperative hospital stay of study group were shortened, and intraoperative blood loss was reduced (P<0.05). Compared with preoperatively in the same group, postoperative TBIL and ALT levels of the two groups decreased, and HGF levels increased (P<0.05). There was no significant difference in the levels of TBIL, ALT, and HGF between the two groups before surgery (P>0.05); at 1 month after surgery, there was no significant difference in the levels of TBIL and ALT between the two groups (P>0.05), but the HGF level of the study group was higher than that of the control group at1 month after operation, the difference was statistically significant (P<0.05). The changes before and after operation of TBIL and ALT were similar between the two groups (P>0.05), but the rising value of HGF in the study group was higher than that of the control group (P<0.001). There was no death in the two groups during the perioperative period, and the total postoperative complications were not statistically different (P=0.677). There was no statistically significant difference in the postoperative follow-up results between the two groups in recurrence, metastasis, and death (P>0.05).ConclusionRe-hepatectomy through the round ligament fissure approach can reduce the amount of intraoperative blood loss, shorten the operation time, and reduce the damage to the residual liver, which has high safety.
ObjectiveTo investigate the clinical feasibility and value of laparoscopic precise segment Ⅳ hepatectomy by guiding of indocyanine green (ICG) fluorescence imaging via ligamenta teres hepatis. MethodThe clinicopathologic data of patients with liver cancer treated in the Department of Liver Surgery of West China Hospital of Sichuan University from January 2017 to December 2021 who underwent precise segment Ⅳ hepatectomy by the guidance of ICG fluorescence imaging through the ligamenta teres hepatis were collected retrospectively. ResultsA total of 6 patients were collected, including 5 males and 1 female. The age ranged from 42 to 78 years. All 6 patients were successfully completed using laparoscopic precise segment Ⅳ hepatectomy by guiding of ICG fluorescence imaging via ligamenta teres hepatis. The operation time was (200±30) min, the intraoperative bleeding was (100±20) mL, and there were no intraoperative blood transfusion, postoperative liver failure, postoperative pneumonia, incision infection, bile leakage, postoperative bleeding, and other complications. The postoperative hospital stay was (7±2) d. One patient with positive microvascular invasion was found after operation and recurred at 38 months after operation, then treated by radiofrequency ablation and didn’t recur. No patient died during the follow-up period in 6 patients. ConclusionFrom results of limited cases in this study, laparoscopic precise segment Ⅳ hepatectomy by guiding of ICG fluorescence imaging via ligamenta teres hepatis is safe, feasible, and effective.