Transthoracic Transdiaphragmatic Approach for Hepatectomy of Couinaud’s Segments VII and VIII

For hepatectomy of Couinaud’s segment VII or VIII, severe compression and mobilization of the liver is required to establish the operative field via the usual transabdominal approach. Compression of the cirrhotic liver impairs hepatic and systemic blood circulation, which may cause liver dysfunction...

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Bibliographic Details
Published in:World journal of surgery 1997-01, Vol.21 (1), p.86-90
Main Authors: Ko, Saiho, Nakajima, Yoshiyuki, Kanehiro, Hiromichi, Aomatsu, Yukio, Yoshimura, Atsushi, Taki, Junichiro, Kin, Tatsuya, Yagura, Kazuaki, Ohashi, Kazuo, Nakano, Hiroshige
Format: Article
Language:English
Subjects:
Chi-Square Distribution
Cirrhotic Liver
Cirrhotic Patient
Female
Hepatectomy - methods
Hepatocellular Carcinoma
Humans
Liver Cirrhosis
Liver Cirrhosis - complications
Liver Cirrhosis - surgery
Liver Neoplasms - complications
Liver Neoplasms - surgery
Male
Middle Aged
Operative Field
Postoperative Complications
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Summary:For hepatectomy of Couinaud’s segment VII or VIII, severe compression and mobilization of the liver is required to establish the operative field via the usual transabdominal approach. Compression of the cirrhotic liver impairs hepatic and systemic blood circulation, which may cause liver dysfunction. We adopted a transthoracic transdiaphragmatic approach for hepatectomy of segment VII or VIII in cirrhotic patients to establish a good operative field without compressing the liver. The aim of this study was to evaluate the benefits of this approach. Forty‐four patients with hepatocellular carcinoma (HCC) complicating liver cirrhosis who underwent limited hepatectomy of Couinaud’s segment VII or VIII were studied. The patients were randomized to two groups preoperatively: group I (n= 22), transabdominal approach; group II (n= 22), transthoracic transdiaphragmatic approach. There were no differences in preoperative liver function tests, hepatic functional reserve, or extent of tumor between the two groups. The operative time in group II was significantly shorter than that in group I (243 ± 50 versus 313 ± 80 minutes;p< 0.01). Operative blood loss in group II was also significantly smaller than that in group I (1190 ± 1098 versus 2679 ± 2267 g;p< 0.01). Serum lactate dehydrogenase levels on postoperative day 1 in group II were significantly lower than those in group I (587 ± 154 versus 791 ± 383 IU/L;p< 0.05). Major postoperative complications were significantly fewer in group II. It was concluded that the transthoracic transdiaphragmatic approach is a useful method for hepatectomy of segments VII and VIII in cirrhotic patients.
ISSN:0364-2313
1432-2323
DOI:10.1007/s002689900198