Minimally invasive surgery versus open hepatectomy for hepatolithiasis: A systematic review and meta analysis

Objective: Hepatectomy for hepatolithiasis can be performed by following an open approach or a minimally invasive surgery (MIS) approach. MIS is associated with theoretical advantages, but there is no consensus regarding to the best treatment method for hepatolithiasis. The objective of this study was to evaluate the clinical outcomes of MIS hepatectomy compared with those of open hepatectomy in hepatolithiasis patients.

Methods: A systematic literature search was performed using PubMed, Embase and Cochrane Library databases. The data were analyzed with Stata version 12.0 software. Meta-regression analysis was used to explore the potential sources of heterogeneity. Egger's tests and Begg's funnel plots were employed to evaluate the publication biases.

Results: In total, 12 nonrandomized controlled trials were identified. Compared with open hepatectomy, the volume of intraoperative blood loss was significantly less in MIS hepatectomy (SMD = -0.226, P = 0.000). The intraoperative blood transfusion rate was also lower in MIS hepatectomy (RR = 0.569, P = 0.003). A shorter length of postoperative hospital stay was noted with MIS hepatectomy (SMD = -0.537, P = 0.000). MIS hepatectomy resulted in a lower rate of postoperative complications than open hepatectomy (RR = 0.595, P = 0.000). However, MIS hepatectomy resulted in a longer operation time (SMD = 0.473, P = 0.005). No significant differences were noted between MIS and open hepatectomy in the initial stone clearance rate (RR = 1.33, P = 0.218), the final stone clearance rate (RR = 1.040, P = 0.131), the stone recurrence rate (RR = 0.558, P = 0.072) or the cholangitis recurrence rate (RR = 0.610, P = 0.285).

Conclusions: MIS hepatectomy is a safe approach for hepatolithiasis patients. MIS hepatectomy significantly reduces intraoperative blood loss, blood transfusion, postoperative hospital stay time and complications. The stone clearance and recurrence rates were similar for MIS hepatectomy and open hepatectomy. Additional well-designed randomized controlled trials and Western studies are needed to confirm these findings.