[Major hepatic resections. 74 home cases and general review (author's transl)]

Reporting 74 home cases and data of recent litterature, the Authors try to take stock of major hepatic resection in 1978. Technical difficulties are recalled. The control of vena cava and major hepatic veins remains critical. So are blood coagulation troubles (6 cases). The technical choice amounts of either the ruled hepatectomy first described by J. L. Lortat-Jacob, or the finger-fracture technique. The latter should be preferred in resection for trauma (faster with healthy liver and on unchanged anatomy). In any other cases, we prefer the ruled technique. So do many authors. Vascular isolation techniques should deserve a larger use cross-clamping techniques are available for huge posterior tumours, in normovolhemic and healthy hearted patients. This procedure is fairly advisable in case of significant hemorragic risks. It might increase the resecavility rate (27). Tight monitoring and heavy material means make it available only in specialized centers. Intra-caval shunts, first conceived for caval and hepatic wounds, are an isolation procedure of choice in trauma and hypovolhemy. A larger experience should make the indications more precise. Advance in hepatectomy should reduce morbidity and mortality rates to those of other major digestive surgery. The post-operative course is studied; hemorrhagic and septic complications head the list. The biliary drainage is discussed: its indications should be consistantly reduced. Coagulation troubles and metabolic problems are analyzed advance in hepatic regeneration is pointed out. Indications of major hepatic resections are studied. It seems they should be spead out.