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Hepatectomy including more than half of liver volume with intermittent portal triad occlusion
J Calleja Kempín1, J Guarnizo Clemente, J Martín Cavanna
1Departamento de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid.
Introduction:
Liver resections over 50% of hepatic volume can be achieved with a low morbi-mortality, although occasionally they are followed by severe complications. Postoperative evolution and complications after this type of hepatic resections with intermittent occlusion of the portal triad have been studied.
Patients And Methods:
13 right hepatectomies, 5 enlarged right hepatectomies and 2 enlarged left hepatectomies were performed consecutively, with intraoperative ultrasound evaluation and intermittent portal triad occlusion.
Results:
Maximum time of continuous hepatic hilum occlusion was 15 minutes, with a mean isquemia time of 25 +/- 8.6 minutes. Peak of disturbance of hepatic function was at 24 hours and recovered totally at 7th postoperative day. Nine of the 20 patients (45%) did not need intraoperative transfusion and the average of transfusion was 1.8 +/- 1.9 blood units. Four biliary leaks (20%), with no severe hepatic disfunction were observed during postoperative period, and there was no hospital mortality.
Conclusions:
Intermittent portal triad occlusion during hepatic resections in more than 50% of liver volume is a safe surgical maneuver.