Abstract:Objective: To determine the feasibility, safety and effectiveness of total laparoscopic left hepatic pedicle occlusion and left hepatectomy in treatment of intra-and extrahepatic bile duct stones. Methods: The clinical data of 32 patients with intra- and extrahepatic bile duct stones undergoing surgical treatment (procedures compromised left hepatectomy, cholecystectomy, choledochotomy, choledochoscopic stone extraction and T-tube drainage) from September 2010 to December 2015 were retrospectively analyzed. Of the patients, 18 cases underwent total laparoscopic surgery with left hepatic pedicle occlusion (laparoscopic group) and 14 cases underwent traditional open surgery (laparotomy group). The relevant clinical variables between the two groups of patients were compared. Results: The preoperative data between the two groups of patients were comparable. All patients were operated successfully, and no conversion was required in laparoscopic group. In laparoscopic group compared with laparotomy group, the operative time was prolonged (273.0 min vs. 214.0 min, P<0.05) and the cost for surgery was increased (5 550.0 yuan vs. 3 962.0 yuan, P<0.05), but significant difference was noted in postoperative alanine aminotransferase level (postoperative day 1: 158.2 U/L vs. 291.5 U/L, postoperative day 7: 33.3 U/L vs. 52.2 U/L), time for pain relief (3.2 h vs. 5.0 h), time to first passage of gas (23.3 h vs. 45.5 h), and length of postoperative hospital stay (12.0 d vs. 15.7 d) (all P<0.05). There was no statistical significance in intraoperative blood loss (226.7 mL vs. 189.3 mL), total hospitalization costs (41 304.4 yuan vs. 41 399.8 yuan) and overall incidence of postoperative complications (11.2% vs. 21.3%) between the two groups (all P>0.05). No residual stone was seen in any of the patients in the two groups. Conclusion: Total laparoscopic left hepatic pedicle occlusion and left hepatectomy is simple, safe and effective in treatment of intra-and extrahepatic bile duct stones. Although the operative time is somewhat prolonged, it has the advantages of less trauma and pain, as well as fast recovery and short hospitalization, so it deserves to be used in clinical practice.