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World Journal of Surgery

, Volume 20, Issue 3, pp 314–318 | Cite as

Anterior Approach for Difficult Major Right Hepatectomy

  • Edward C.S. Lai
  • Sheung-Tat Fan
  • Chung-Mau Lo
  • Kent-Man Chu
  • Chi-Leung Liu

Abstract. In selected patients with huge right hepatic tumors that had infiltrated the surrounding structures, injudicious mobilization of the liver before transection, as in the conventional manner, may result in excessive bleeding, prolonged ischemia from rotation of the hepatoduodenal ligament, and spillage of cancer cells into the systemic circulation. Alternatively, the “anterior” approach, which involves initial completion of the parenchymal transection before the right hepatic lobe is mobilized, can be adopted for these patients with difficult right hepatic tumors. After hilar control of the inflow vessels, liver parenchyma was transected using an ultrasonic dissector until the anterior surface of the inferior vena cava is exposed. The right hepatic lobe is then mobilized laterally by securing all venous tributaries, including the right hepatic vein. The prospective data of 25 patients who had major right hepatectomy using the “anterior” approach were compared with data from 34 patients who had their operation performed in the conventional manner. Despite the facts that larger tumors (

p < 0.004), more extrahepatic structures ( p < 0.05), and the caudate lobes ( p < 0.03) were resected, the amount of perioperative blood transfusion, fluid replacement, and outcome between the two groups of patients were comparable. There were three hospital deaths, among which one could be attributed to an intraoperative catastrophe during hepatectomy using the conventional approach. The “anterior” approach is a safe, effective option for selected patients undergoing complicated major right hepatectomy.

Keywords

Hepatic Vein Inferior Vena Liver Parenchyma Anterior Approach Hepatic Tumor 
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.

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Copyright information

© Société Internationale de Chirugie 1996

Authors and Affiliations

  • Edward C.S. Lai
    • 1
  • Sheung-Tat Fan
    • 1
  • Chung-Mau Lo
    • 1
  • Kent-Man Chu
    • 1
  • Chi-Leung Liu
    • 1
  1. 1.Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong KongHK

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