Expert consensus on laparoscopic treatment of hepatolithiasis (2013 edition)

The incidence of hepatolithiasis in some regions of China is still high. Although laparoscopic treatment of hepatolithiasis is increasingly carried out in medical centers year by year, the technical level between regions varies, and systematic and standardized programs have not been formed in terms of case selection and technical methods. So a consensus is made according to the results of full discussion of known experts in the related fields. The principle of laparoscopic treatment of hepatolithiasis was advocated by academician HUANG Zhiqiang, and it includes “removal of lesions, relief of obstruction, alleviation of stricture and retaining of the drainage of bile duct”. The surgical indications of laparoscopic treatment of hepatolithiasis include typeⅠand a part of type Ⅱ hepatolithiasis. The surgical procedures include laparoscopic hepatectomy, laparoscopic bile duct incision+choledochoscopic exploration and (or) lithotomy and laparoscopic bilioplasty and (or) bilioenteric anastomosis. Most of the hepatolithiasis patients need to undergo joint surgery which is dominated by laparoscopic hepatectomy. Laparoscopic hepatectomy is the basic surgical procedure for the treatment of hepatolithiasis, and anatomical resection is the key point for achieving excellent efficacy and reducing residual stones and recurrence. Laparoscopic bile duct incision+choledochoscopic exploration and (or) lithotomy can avoid the stones missing, biliary stricture and obstruction to the greatest extent, and it can also be used alone as a definitive surgery for few hepatolithiasis patients; the efficacy of laparoscopic bilioplasty and (or) bilioenteric anastomosis is still under research, which could be carried out by skilled laparoscopic biliary surgery experts or surgeons with the assistance of da Vinci surgical robotic system. The effects of laparoscopic ultrasound and anatomical hepatectomy are specially emphasized in laparoscopic treatment of the hepatolithiasis; planned conversion to open surgery should not be regarded as a failure or complications of laparoscopic surgery, but a shift of surgical procedure. The efficacy of laparoscopic treatment of hepatolithiasis should be evaluated according to the results of imaging examinations (Bultrasound, computed tomography, magnetic resonance imaging/magnetic resonance cholangiopancreatography, T tube cholangiography), choledocoscopic exploration, hepatic function test as well as recovery of the condition of patients and rating of quality of life.