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Minerva Chirurgica 2020 Aug 06

DOI: 10.23736/S0026-4733.20.08250-4


lingua: Inglese

Outcomes of reoperation for hepatolithiasis with 3D imaging individualized preoperative planning technique: a single-center experience

Tianchong WU 1, Yuehua GUO 1, Jiangang BI 1, Baochun HE 2, Shiyun BAO 1

1 Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People’s Hospital(The Second Clinical Medical College,Jinan University;The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong Province, China; 2 Research Lab for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China


BACKGROUND: A detailed assessment of biliary tract anatomy is necessary for the successful reoperation for hepatolithiasis. This study aimed to evaluate the feasibility of preoperative individualized surgical planning with three-dimensional (3D) imaging technique for reoperation of hepatolithiasis.
METHODS: This was a retrospective matched case-control study. From January 2011 to December 2018, 56 patients receiving reoperation according to the individualized preoperative plan based on 3D imaging at our center were included (group A). Meanwhile, 54 patients receiving traditional imaging guided reoperation matched by age, gender and distribution of hepatobiliary stones to each case were selected as controls (group B). The perioperative and long-term follow-up outcomes were compared between the two groups.
RESULTS: There was no significant difference in demographic characteristics between groups. Compared with group B, the group A had a significantly shorter operation time (245.7±56.2min vs. 305.2±79.9min, P<0.001), a significantly higher surgical plan implementation rate (SPIR, 92.9% vs. 66.7%, P=0.001) and a lower incidence of severe complications (Clavien-Dindo grade>II, 1.8% vs. 14.8%, P=0.015). The incidences of initial residual stone (7.1% vs. 44.4%, P<0.001) and repeated cholangitis (3.6% vs. 33.3%, P<0.001) were significantly lower in group A than in group B. After postoperative choledochoscopic lithotripsy, the incidence of final residual stones was significantly lower in group A than in group B. (1.8% vs. 20.4%, P=0.002).
CONCLUSIONS: The preoperative 3D imaging assisted surgical planning is feasible and safe for reoperation of hepatolithiasis which can effectively improve surgical plan implementation rate and reduce the incidence of postoperative complications as compared with conventional surgical planning.

KEY WORDS: Hepatolithiasis; Reoperation; 3D imaging technique

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