# A Case Report and Surgical Video Presentation on the Anterior Approach for Right Anterior Hepatectomy: A Solution to Complex Biliary Pathologies

## TL;DR

This case report describes a successful laparoscopic right anterior hepatectomy using an anterior approach to treat complex biliary stones and strictures in a patient with intrahepatic hepatolithiasis.

## Contribution

The paper presents a novel surgical approach for managing complex biliary pathologies using an anterior laparoscopic technique.

## Key findings

- The anterior approach enabled successful resection of the affected liver segment and removal of stones and strictures.
- The patient had an uneventful recovery with no recurrence observed during initial follow-up.
- The procedure was performed laparoscopically, minimizing trauma and promoting faster recovery.

## Abstract

Intrahepatic hepatolithiasis, characterized by the presence of stones in the intrahepatic bile ducts, is often associated with biliary strictures and chronic inflammation, complicating surgical management. Patients with this condition frequently experience recurrent cholangitis and face a high risk of hepatic complications. Segmental laparoscopic hepatectomy is an effective therapeutic option that removes both stones and the affected liver tissue.

This study presents the case of a 40-year-old female with a history of laparoscopic cholecystectomy three years ago, a lesion in the right hepatic duct, a user of a bile duct stent, and under follow-up with hepato-pancreato-biliary (HPB) surgery. She was currently asymptomatic. Magnetic resonance cholangiopancreatography (MRCP) revealed stenosis of the anterior duct, suggestive of hepatolithiasis. The patient was admitted for elective surgical resolution and treated with right anterior hepatectomy using an anterior approach under conditions of significant inflammation.

This analysis was based on a retrospective review of the patient’s medical records and intraoperative video documentation.

The procedure was performed at Hospital Clínico Pontificia Universidad Católica de Chile. An anterior approach was chosen to perform the anterior right segmental hepatectomy due to the severe inflammation, which made identifying critical anatomical structures challenging. The surgery was performed laparoscopically to minimize surgical trauma and promote faster recovery. Intraoperative rapid biopsies were used to ensure clear margins.

The surgery successfully resected the affected hepatic segment, eliminating both the stones and the stricture. The patient had an uneventful postoperative course. No re-interventions were required, and the patient was discharged in good general condition, with no recurrence observed during the initial follow-up.

This case report was previously presented as a meeting video at the 2025 AHPBA meeting held in Miami, USA, on March 20-23, 2025.