Left hepatectomy after right paramedian sectoriectomy.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Repeat hepatectomy is crucial for managing recurrent liver malignancies.
• Complex prior hepatectomies, especially those exposing hepatic veins and portal pedicles, increase surgical difficulty.
• Adhesions and anatomical changes post-surgery pose significant challenges.

Purpose of the Study:

• To describe the surgical technique of left hepatectomy following right paramedian sectoriectomy (RPMS).
• To evaluate the feasibility and postoperative outcomes of this complex repeat hepatectomy procedure.
• To demonstrate a safe approach for managing challenging adhesions between major hepatic veins.

Main Methods:

• Performed left hepatectomy after right paramedian sectoriectomy (RPMS) in three patients.
• Utilized a meticulous dissection along fibrous planes for safe adhesiolysis between middle and right hepatic veins.
• Calculated remnant liver volume and monitored for postoperative complications.

Main Results:

• The procedure involved a mean operative time of 8.7 hours, with 4.9 hours dedicated to adhesiolysis.
• Mean remnant liver volume was 704 ml (62% of total liver volume), comprising the right lateral sector and caudate lobe.
• No postoperative liver failure or mortality was observed in the patient cohort.

Conclusions:

• Left hepatectomy after RPMS is a viable surgical option for selected patients with recurrent liver malignancies.
• The technique allows for safe dissection of adhered hepatic veins, even when they run closely after regeneration.
• Adequate remnant liver volume is essential for successful outcomes in these complex repeat hepatectomies.