Low Mortality Major Hepatectomy

Background/aims: A retrospective series of major hepatectomy using a simple strategy.

Methodology: From 1995 to 2002, 104 major hepatectomies were performed, including 16 extended and 35 right/left lobectomies, 11 bisegmentectomies, and 42 left lateral segmentectomies. Seventy-two patients had malignant tumors. Chronic hepatitis was present in 9 and mild to severe cirrhosis in 16 of 47 hepatocellular carcinomas. Intrahepatic duct stone constituted 28 of 32 patients with benign disease. Hilar ligation without pedicle clamp for lobectomy and Pringle's maneuver for segmentectomy were initially our standard procedures. Since 1997, Chang's needle was applied on 34 patients to block hepatic inflow and outflow by entire thickness, interlocking mattress sutures.

Results: Three patients (2.9%) died postoperatively. Of the two cholangiocarcinoma patients, one underwent extended right lobectomy and died of multiple organ failure and the other underwent left lateral segmentectomy and died of AMI unrelated to the surgery. One hepatocellular carcinoma patient underwent left lateral segmentectomy and died of hepatic failure. Significant complications (11.5%) included three bile leaks (2.9%), six abscesses (5.8%), one hepatic failure (1%), one ileus (1%), and one ventral hernia (1%). One major bile leak necessitated a reconstructive surgery.

Conclusions: Our strategies for hepatic resection are simple, however we are able to achieve a low mortality major hepatectomy.