Clinical outcomes after laparoscopic left hemihepatectomy with and without biliary duct exploration

Background: The operative procedures of laparoscopic left hemihepatectomy (LLH) with and without common bile duct (CBD) exploration are largely different. However, the two procedures are frequently included in the same category. The present study aimed to evaluate the impact of CBD exploration on clinical outcome in patients undergoing LLH, especially postoperative liver function and biliary leakage. Methods: The retrospective study included patients with left-sided intrahepatic bile duct stones at the First Affiliated Hospital of Nanchang University from January 2020 to June 2024. Patients were divided into simple LLH group and LLH with CBD exploration (LLHCBDE) group. Perioperative outcomes and stone recurrence between the two groups were evaluated. Moreover, we performed multivariable linear regression to analyze peak postoperative levels of alanine transaminase (ALT) and aspartate transaminase (AST) and logistic regression to analyze the occurrence of biliary leakage. Results: This study enrolled 176 patients, with 36 and 140 patients in the LLH and LLHCBDE groups, respectively. The LLHCBDE group demonstrated significantly longer operation time, longer hospital stays, higher peak postoperative transaminase levels, and a higher stone recurrence rate compared to the LLH group. However, there were no significant differences in the incidence of major complications and biliary leakage between the two groups. Multivariate stepwise linear regression analysis revealed that CBD exploration was an independent predictor of peak postoperative levels of alanine transaminase (β = 0.313, P < 0.001) and aspartate transaminase (β = 0.359, P < 0.001). Furthermore, period of less than 1 month between LLH and the latest episode of acute cholangitis (OR 4.362, 95%CI 1.126-16.904, P =0.033) and intraoperative blood loss (OR 1.022, 95%CI 1.013-1.031, P <0.001) were independent risk factors for postoperative biliary leakage. Conclusions: LLH with CBD exploration should be considered as a different procedure from LLH. CBD exploration is significantly associated with higher peak postoperative levels of ALT and AST, but not with an increased risk of biliary leakage.