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Enterothorax After Hepatic Surgery: A Single-Center Experience

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Abstract

Background

Enterothorax (ET) is a rare complication after hepatic surgery. The literature in this field is limited and mainly based on case reports. The aim of this study was to review our department’s experience.

Patients and methods

We retrospectively analyzed 602 patients who underwent hepatic resection between November 2008 and December 2016. Major hepatic surgery (n = 321) was defined as right or extended right hepatectomy (n = 227), left or extended left hepatectomy (n = 63), trisegmentectomy (n = 13), and living donor liver transplantation (n = 18). ET cases were identified by analyzing clinical courses and radiological imaging.

Results

ET was observed in five out of 602 patients (0.8%). All patients developed the complication after major hepatic surgery (five out of 321, 1.6%). ET exclusively occurred after right (n = 3) or extended right hepatectomy (n = 2). Median time to diagnosis was 22 months. Radiological imaging showed herniation of small (n = 2), large bowel (n = 2), or omental fat (n = 1) with a median diaphragmatic defect of 3.9 cm. Two patients presented with acute incarceration and underwent emergency surgery, one patient reported recurrent pain and underwent elective repair, and two patients refused surgery. Follow-up imaging in two operated patients showed no recurrence of ET after 36 and 8 months.

Conclusions

Patients after right hepatectomy have a substantial risk of ET. Acute right upper quadrant pain and/or dyspnea after hepatectomy should be investigated with adequate radiological imaging. Elective surgical repair of ET is recommended to avoid emergency surgery in case of incarceration.

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Authors and Affiliations

  1. Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    G. Manzini, C. Kuemmerli, H. Petrowsky & C. A. Gutschow

  2. Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    C. S. Reiner

Authors
  1. G. Manzini
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  2. C. Kuemmerli
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  3. C. S. Reiner
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  4. H. Petrowsky
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  5. C. A. Gutschow
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Corresponding author

Correspondence to C. A. Gutschow.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Institutional review board approval was obtained for this study (BASEC-Number 2017-01878).

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Manzini, G., Kuemmerli, C., Reiner, C.S. et al. Enterothorax After Hepatic Surgery: A Single-Center Experience. World J Surg 43, 902–909 (2019). https://doi.org/10.1007/s00268-018-4838-9

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  • DOI: https://doi.org/10.1007/s00268-018-4838-9

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