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Updated: Jun 8, 2026
Partial Lobular Hepatectomy: A Surgical Model for Morphologic Liver Regeneration
Published on: May 31, 2018
Treatment of major hepatic necrosis: lobectomy versus serial debridement
Danielle N Dabbs1, Deborah M Stein, Benjamin Philosophe
1R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
Background:
Major hepatic necrosis (MHN) is a common complication after angioembolization (AE) for severe liver injuries. We compared the outcomes of two treatment modalities.
Methods:
Patients with MHN were retrospectively reviewed from January 2002 to October 2007. Demographics, Injury Severity Scale score, length of stay, admission Glasgow Coma Scale Score, mortality, transfusion requirements, intra-abdominal complications, admission physiologic variables, and the number and type of abdominal procedures (operative or nonoperative) were collected. These patients were then divided into two groups-those treated with hepatic lobectomy (HL) and those treated with multiple procedures including serial operative debridements and/or percutaneous drainage (IR/OR).
Results:
Thirty patients (41%) with MHN were identified from 71 patients who had AE. Sixteen patients with MHN underwent HL and 14 patients underwent multiple IR/OR procedures. The two groups were similar at baseline, except that the HL group had a higher Injury Severity Scale score. Outcomes between the two groups were similar. There was a significantly higher complication rate and increased number of procedures in the IR/OR group. There were no deaths in patients who had early HL (<5 days). There was one death in the later lobectomy group.
Conclusion:
MHN is a common complication after AE. This complication can be safely managed with a series of operative debridements in conjunction with interventional procedures or with HL. Lobectomy is associated with a lower complication rate and a fewer number of procedures. Early lobectomy may be better than a delayed procedure.
Insights
Major hepatic necrosis (MHN) following angioembolization (AE) can be managed with hepatic lobectomy (HL) or multiple procedures. HL resulted in fewer complications and procedures, suggesting early intervention may be beneficial.
Area of Science:
- Hepatobiliary surgery
- Interventional radiology
- Trauma surgery
Background:
- Major hepatic necrosis (MHN) is a frequent complication after angioembolization (AE) for severe liver injuries.
- Treatment outcomes for MHN following AE require further investigation.
Purpose of the Study:
- To compare the efficacy of hepatic lobectomy (HL) versus multiple interventional radiology/operative (IR/OR) procedures for managing MHN post-AE.
Main Methods:
- Retrospective review of 71 patients who underwent AE for liver injuries from 2002-2007.
- Identified 30 patients with MHN, comparing outcomes between 16 treated with HL and 14 with IR/OR procedures.
- Collected data included demographics, injury severity, length of stay, mortality, complications, and procedural details.
Main Results:
- Both HL and IR/OR groups had similar baseline characteristics, though the HL group had higher Injury Severity Scale scores.
- Overall outcomes were comparable, but the IR/OR group experienced a higher complication rate and required more procedures.
- No deaths occurred in patients undergoing early HL (<5 days), while one death occurred in the delayed lobectomy group.
Conclusions:
- MHN is a common complication after AE and can be managed non-operatively or with HL.
- Hepatic lobectomy is associated with a lower complication rate and fewer procedures compared to serial debridements and drainage.
- Early hepatic lobectomy may offer superior outcomes in managing MHN post-angioembolization.
