Abstract: Objective The aim of this study was to compare the clinical efficacy of first laparoscopic hepatectomy (LH) and thereafter common bile duct incision for stone removal, or vice versa in the treatment of patients with intrahepatic bile duct stones (IHBDS). Methods 90 patients with IHBDS were enrolled in our hospital between January 2017 and October 2021, and the 53 patients in group A received first LH and thereafter common bile duct incision for stone removal and 37 patients in group B received first common bile duct incision for stone removal and thereafter LH. All patients were followed-up for six months. Results The surgical time, postoperative drainage tube removal and postoperative hospital stay in group A were(226.1±45.3)min, (7.1±1.8)d and (8.0±1.5)d, all significantly shorter than [(294.5±58.8)min, (8.4±2.0)d and (9.7±2.4)d, respectively, P<0.05], and intraoperative blood loss was (215.4±39.7)ml, also significantly less than [(328.2±37.2)ml, P<0.05] in group B; there were no significant differences as respect to blood biochemical parameters between the two groups at presentation and 5 days after operation(P>0.05); at the end of three month follow-up, the incidences of post-operational complications, such as incision infection, ascites, bile leakage, biliary bleeding and cholangitis between the two groups were not significantly different(13.2% vs. 24.3%, P>0.05); at the end of six month follow-up, the stone recurrence rates were not statistically significant between the two groups (5.7% vs 8.1%, P>0.05). Conclusion The first LH and thereafter common bile duct incision for stone removal, or vice versa in the treatment of patients with IHBDS could not lead to a different outcomes of patients, and the surgeons might make the decisions based the patients' conditions. We vigorously recommend them to summarize the clinical experiences to give out the indications.

Key words: Intrahepatic bile duct stones, Laparoscopic hepatectomy, Common bile duct incision for stone removal, Therapy