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Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
Portal Hypertension01:22

Portal Hypertension

Portal hypertension is an increase in blood pressure within the portal venous system. Normally, this pressure is less than 5 mmHg. It is considered clinically significant when it rises above 10 mmHg. At this threshold, complications from altered blood flow and venous congestion emerge.EtiologyPortal hypertension arises from conditions that impede blood flow through the liver. The most common cause is cirrhosis, in which chronic liver injury leads to fibrotic scarring. This fibrosis narrows or...

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Related Experiment Video

Updated: Jun 15, 2026

Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach
05:30

Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach

Published on: August 8, 2025

Risk factors for massive bleeding during major hepatectomy.

Ken Shirabe1, Kiyoshi Kajiyama, Norifumi Harimoto

  • 1Department of Hepatogastroenterological Surgery, Aso Iizuka Hospital, Iizuka, 820-8505, Japan. kshirabe@surg2.med.kyushu-u.ac.jp

World Journal of Surgery
|February 26, 2010
PubMed
Summary

Massive bleeding during hepatectomy is linked to specific surgical factors. Identifying these risks, such as right major hepatectomy for large primary liver cancers with IVC compression, can improve patient outcomes.

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Related Experiment Videos

Last Updated: Jun 15, 2026

Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach
05:30

Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach

Published on: August 8, 2025

Application of Hemostatic Devices in Laparoscopic Hepatectomy
04:23

Application of Hemostatic Devices in Laparoscopic Hepatectomy

Published on: April 19, 2022

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
12:27

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver

Published on: June 16, 2023

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • Massive bleeding during hepatectomy presents significant mortality and morbidity risks.
  • Understanding risk factors for massive bleeding is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify risk factors associated with massive bleeding during hepatectomy.
  • To correlate these risk factors with perioperative outcomes.

Main Methods:

  • Retrospective case series of 353 hepatectomized patients.
  • Comparison of perioperative factors between patients with estimated blood loss (EBL) ≤ 5000 ml and > 5000 ml undergoing right major hepatectomy (RMH) for primary liver cancer (PLC).

Main Results:

  • Massive EBL (> 5000 ml) occurred in 1.4% of patients, all undergoing RMH for PLC.
  • Larger tumor size (mean 15.1 cm vs 7.9 cm) and inferior vena cava (IVC) compression were significantly associated with massive bleeding.
  • An anterior surgical approach without the liver-hanging maneuver (LHM) was more common in patients with massive bleeding.

Conclusions:

  • Right major hepatectomy for large primary liver cancers with IVC compression, especially using an anterior approach without LHM, are significant risks for massive bleeding.
  • Proactive preparation for rapid fluid infusion is essential in high-risk cases to prevent hypotension.