Advertisement

World Journal of Surgery

, Volume 34, Issue 9, pp 2162–2167 | Cite as

Surgical Treatment of Giant Liver Hemangiomas: Enucleation with Continuous Occlusion of Hepatic Artery Proper and Intermittent Pringle Maneuver

  • Feng Xia
  • Wan-Yee Lau
  • Cheng Qian
  • Shuguang Wang
  • Kuansheng Ma
  • Ping BieEmail author
Article

Abstract

Background

The present study was designed to investigate the efficacy and safety of continuous occlusion of the hepatic artery proper combined with intermittent use of the Pringle maneuver for reduction of blood loss during enucleation of giant liver hemangiomas.

Methods

A retrospective study was performed on 115 patients who underwent enucleation of giant liver hemangiomas with or without continuous occlusion of the hepatic artery proper at a tertiary care university hospital. The characteristics of patients and perioperative parameters including intraoperative blood loss, the degree of ischemia–reperfusion injury, the incidence and severity of postoperative complications, and the length of hospital stay were summarized and compared in the two groups.

Results

Seventy-three and 42 patients underwent enucleation of hepatic hemangiomas with and without continuous occlusion of the hepatic artery proper, respectively. The Pringle maneuver was routinely used in all patients in cycles of 15/5 min of clamp/unclamp times. Patient characteristics were comparable between the two groups. Intraoperative blood loss and blood transfusion in the continuous occlusion group were significantly lower than in the non-occlusion group (P < 0.001 and P = 0.012, respectively). In a comparison of the two groups, there were no significant differences in the changes of the perioperative serum aspartate transaminase and total bilirubin levels (P = 0.086, P = 0.829, respectively), and in the postoperative hospital stay and surgical complications according to Clavien’s classification (P = 0.378, P = 0.227, respectively).

Conclusions

Continuous occlusion of the hepatic artery proper when added to intermittent use of the Pringle maneuver significantly reduced intraoperative blood loss when compared with intermittent Pringle maneuver alone. Enucleation of giant hepatic hemangiomas using continuous occlusion of the hepatic artery proper in addition to intermittent application of the Pringle maneuver for up to 1 h was safe.

Keywords

Hepatic Artery Hemangioma Pringle Maneuver Postoperative Serum Hepatic Hemangioma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This work was supported by National S&T Major Project (No. 2008ZX10002-026). The authors are grateful to our research assistants Zhongfang Jie and Hua Li for their help with data collection and statistical analyses.

References

  1. 1.
    Fu XH, Lai ECH, Yao XP et al (2009) Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions? Am J Surg 198:184–187CrossRefPubMedGoogle Scholar
  2. 2.
    Erdogan D, Busch OR, van Delden OM et al (2007) Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol 22:1953–1958CrossRefPubMedGoogle Scholar
  3. 3.
    Lerner SM, Hiatt JR, Salamandra J et al (2004) Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg 139:818–821CrossRefPubMedGoogle Scholar
  4. 4.
    Blumgart LH (2000) Liver resection for benign disease and for liver and biliary tumors. In: Blumgart LH, Fong Y (eds) Surgery of the liver and biliary tract, 3rd edn. W.B. Saunders, Philadelphia, pp 1639–1713Google Scholar
  5. 5.
    Baer HU, Dennison AR, Mouton W et al (1992) Enucleation of giant hemangiomas of the liver. Technical and pathologic aspects of a neglected procedure. Ann Surg 216:673–676CrossRefPubMedGoogle Scholar
  6. 6.
    Schwartz SI (1987) Cavernous hemangioma of the liver: a single institution report of 16 resections. Ann Surg 205:456–465CrossRefPubMedGoogle Scholar
  7. 7.
    Starzl TE, Koep LJ, Weil R et al (1980) Excisional treatment ofcavernous hemangioma of the liver. Ann Surg 192:25–27CrossRefPubMedGoogle Scholar
  8. 8.
    Giavroglou C, Economou H, Ioannidis I (2003) Arterial embolization of giant hepatic hemangiomas. Cardiovasc Intervent Radiol 26:92–96CrossRefPubMedGoogle Scholar
  9. 9.
    Srivastava DN, Gandhi D, Seith A et al (2001) Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging 26:510–514CrossRefPubMedGoogle Scholar
  10. 10.
    Vassiou K, Rountas H, Liakou P et al (2007) Embolization of a giant hepatic hemangioma prior to urgent liver resection. Case report and review of the literature. Cardiovasc Intervent Radiol 30:800–802CrossRefPubMedGoogle Scholar
  11. 11.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedGoogle Scholar
  12. 12.
    Gedaly R, Pomposelli JJ, Pomfret EA et al (1999) Cavernous hemangioma of the liver: anatomic resection vs. enucleation. Arch Surg 134:407–411CrossRefPubMedGoogle Scholar
  13. 13.
    Hamaloglu E, Altun H, Ozdemir A et al (2005) Giant liver hemangioma: therapy by enucleation or liver resection. World J Surg 29:890–893CrossRefPubMedGoogle Scholar
  14. 14.
    Alper A, Ariogul O, Emre A et al (1988) Treatment of liver hemangiomas by enucleation. Arch Surg 123:660–661PubMedGoogle Scholar
  15. 15.
    Singh RK, Kapoor S, Sahni P et al (2007) Giant haemangioma of the liver: is enucleation better than resection? Ann R Coll Surg Engl 89:490–493CrossRefPubMedGoogle Scholar
  16. 16.
    Yoon SS, Charny CK, Fong Y et al (2003) Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg 197:392–402CrossRefPubMedGoogle Scholar
  17. 17.
    Terkivatan T, Vrijland WW, Den Hoed PT et al (2002) Size of lesion is not a criterion for resection during management of giant liver haemangioma. Br J Surg 89:1240–1244CrossRefPubMedGoogle Scholar
  18. 18.
    Tsai HP, Jeng LB, Lee WC et al (2003) Clinical experience of hepatic hemangioma undergoing hepatic resection. Dig Dis Sci 48:916–920CrossRefPubMedGoogle Scholar
  19. 19.
    Ozden I, Emre A, Alper A et al (2000) Long-term results of surgery for liver hemangiomas. Arch Surg 135:978–981CrossRefPubMedGoogle Scholar
  20. 20.
    Popescu I, Ciurea S, Brasoveanu V et al (2001) Liver hemangioma revisited: current surgical indications, technical aspects, results. Hepatogastroenterology 48:770–776PubMedGoogle Scholar
  21. 21.
    Brouwers MA, Peeters PM, de Jong KP et al (1997) Surgical treatment of giant haemangioma of the liver. Br J Surg 84:314–316CrossRefPubMedGoogle Scholar
  22. 22.
    Duron JJ, Keilani K, Jost JL et al (1995) Giant cavernous hepatic hemangiomas in adults: enucleation under selective blood inflow control. Am Surg 61:1019–1022PubMedGoogle Scholar
  23. 23.
    Demiryurek H, Alabaz O, Agdemir D et al (1997) Symptomatic giant cavernous haemangioma of the liver: Is enucleation a safe method? A single institution report. HPB Surg 10:299–304CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Feng Xia
    • 1
  • Wan-Yee Lau
    • 2
  • Cheng Qian
    • 3
  • Shuguang Wang
    • 1
  • Kuansheng Ma
    • 1
  • Ping Bie
    • 1
    Email author
  1. 1.Institute of Hepatobiliary Surgery, Southwest HospitalThird Military Medical UniversityChongqingChina
  2. 2.Faculty of MedicineThe Chinese University of Hong KongShatinChina
  3. 3.Department of PathologyThird Military Medical UniversityChongqingChina

Personalised recommendations