[Surgical approach to the posterior surface of the liver (author's transl)]

Anterior incision does not afford a direct approach to lesions located in the posterior part of the liver, or to right subphrenic and retrohepatic abcesses, and may contaminate the peritoneal cavity in suppurative collections. Posterior incision is a more direct approach. It can be extrapleural and extraperitoneal, or transpleural with exclusion of the pleura when resecting a lower rib; a posterior thoraco-phreno-laparotomy gives a wider exposure. When the pleural cavity has been opened it should be drained and excluded before dealing with the subphrenic lesion. Such an incision is advocated in posterior abscesses of the liver, in those located under the diaphragm or posterior to the liver, as well as in posterior hydatic and biliary cysts. Scannography helps to locate exactly the cavity and makes sure that there is no other cyst or collection. Endoscopic cholangiography supplies valuable information concerning the bile ducts in case of hydatic cyst.