Effect of Prior Hilar Manipulation During Previous Hepatectomy on Surgical Outcomes of Laparoscopic Repeat Hepatectomy.

INTRODUCTION: Laparoscopic repeat hepatectomy (LRH) is an effective treatment for recurrent liver tumors. However, repeat resection can be complicated by dense adhesions around the hepatic hilum and hepatoduodenal ligament, particularly following prior hilar manipulation (PHM) during initial hepatectomy. Nevertheless, the specific impact of PHM on the safety and efficacy of subsequent LRH remains unclear. Therefore, the aim of this study was to investigate the impact of initial hepatectomy with hilar manipulation on the surgical outcomes of LRH. METHODS: We retrospectively analyzed 121 patients who underwent repeat hepatectomy at our institution between 2010 and 2024. The patients were categorized into three groups: LRH with PHM (n = 35), LRH without PHM (n = 59), and open repeat hepatectomy (ORH) with PHM (n = 27). To minimize selection bias, surgical outcomes were compared using two separate propensity score-matching analyses: (1) LRH with vs. without PHM and (2) LRH with PHM vs. ORH with PHM. RESULTS: In the first matched cohort (24 patients in each group), there were no significant differences in surgical outcomes in the LRH with and without PHM groups, including the success rate of hepatoduodenal ligament isolation. In the second matched cohort (17 patients in each group), blood loss was significantly less in the LRH with PHM group than in the ORH with PHM group (50 vs. 440 mL; p < 0.001). Other surgical outcomes, including the success rate of hepatoduodenal ligament isolation, did not significantly differ between groups. CONCLUSION: Laparoscopic repeat hepatectomy appeared feasible in selected patients after prior hilar manipulation, with matched analysis demonstrating a significant reduction in blood loss compared to the open approach.