Liver hemangiomas--surgical point of view

Most of the liver hemangiomas do not change substantially their size for years. In some of the cases they grow, which may correlate to complaints and a risk of complications. Due to the rarity and the benign nature of the pathology, the surgical tactics and the technical methods have not been fully clarified. The goal of the present study is to present the experience of the Department of General and Liver-pancreatic Surgery in the surgical treatment of liver hemangiomas against data of the specialized literature.

In the January 1995-March 2013 period, 101 patients were subjected to liver hemangioma surgery at the Department of General and Liver-pancreatic Surgery, UH "Alexandrovska" Sofia. Main demographic, clinical, diagnostic and surgical procedures have been analyzed.

Of 101 operated patients, 27 (26.7%) were male and 74 (73.3%)--female, aged 25- 77, mean age--50.7. The focal lesion was successfully diagnosed with diagnostic imaging methods: 96.9% with US, 98.3% with CT and 100 % with MRI. We established diagnostic specificity of 60.3%, 55.0% and 85.7%, respectively. The following interventions were performed: 14 large liver resections of three and more segments, 35 left-side lobectomies, 35 enucleations and enucleoresections and 30 mono- and bisegmentectomies. Post-operative complications were observed with 6 (5.9%) patients. None of the patients died.

The combination of modern non-invasive imaging methods reaches diagnostic sensitivity and specificity sufficient to identify the liver hemangioma and take a decision on the therapeutic conduct. The possibilities for surgical treatment is limited and is applied upon strict indications. Liver resections in different volume and enucleations should be applied after correct selection of patients, so as to ensure minimum risk of morbidity and mortality.