Postoperative Complications and Their Management

Abstract

In the last 2 decades, the results of hepatic resections (HR) have significantly improved. This improvement was possible because of the development of new anesthetic techniques, better postoperative care, better patient selection, the development of new technological devices and the specialization of hepatobiliary surgery units. The low mortality in referral centers has extended indication for HRs, allowing surgeons to perform extreme procedures in patients considered unresectable 20 years ago. These extreme procedures include associated vascular resections and reconstruction, ex vivo surgeries and the simultaneous resection of adjacent organs. The incidence of complications and perioperative mortality varies in the literature, between 15–45% and 0–25% respectively. The different criteria used to define morbidity as well as the inclusion (or not) of mild complications (Dindo-Clavien’s Grade 1 and 2) explains in part the variability of morbidity rates in the literature. Different factors have been associated with the development of postoperative complications: blood loss, number of resected segments, preoperative hypoalbuminemia, renal insufficiency, associated biliary procedures, associated vascular procedures, male gender and associated patients comorbidities. In addition, the experience of the surgical team, type of tumor, the moment of indication (elective, urgency, emergency resection), extent of resection, parenchymal quality of the liver (steatosis, steatohepatitis, fibrosis, cirrhosis, post-chemotherapy changes) and patient selection are also key aspects. Reoperations to solve postoperative complications vary between 3 and 19%. The most frequent cause of reoperations is postoperative bleeding and intra-abdominal collections. In this chapter, local specific postoperative complications related to HR are described along with their specific management and prevention.