REMEDIAL SURGICAL PROCEDURES AFTER HEPATECT0MY

Abstract

With the purpose 'of avoiding second surgical interference after 'hepatic resection, charts of 32 patients who had undergone elective hepatic resection in the national Liver Institute between September 1991 and November 1998 were reviewed.

Cases required second surgical interference were reviewed as regard, the initial pathology, initial procedure done, the indication, timing for second surgical interference and second procedure done.

There were 20 men and 12 women. 19 patients were cirrhotic.

The lesions were, 16 (50 %) HCC ( 14 on top of cirrhosis and 2 fibrolamellar subtype), I (3.1 %) intra hepatic cholangiocarcinoma associated with cirrhosis, 3 (9.4 %) carcinoma of gall bladder plus liver involvement associated with cirrhosis, and 12 (17 .5 % ) benign conditions of the liver in the form of: 8 giant Hemangiomas ( I with cirrhosis), 2 liver cell adenorna and 2 hydatid cysts.

9 patients underwent major liver• resection, 8 bisegmentectomy, trisegmentectomy, and 14 non-anatomical resection.

3 patients (9.4o/o) died, one from respiratory failure, second from bleeding esophageal varices, and third from multiple organ failure. Non fatal complications developed in 12 patients 5-X,)

Reoperations were performed in 8 patients, 4 for inadequate resection, I for bleeding from raw surface, I for bile leak, l for wound sinuses, and I for recurrent hydatid cyst.

Malignancy, limited resection in malignant disease, greater operative blood loss, and cirrhosis all contributed to second surgical interference.

Whereas, strict control of diabetes mellitus, major resection for malignant tumors, careful hernostasis during resection, the use of USO & BCI in parenchymal dissection, adequate perioperative antibiotics and the use of closed suction drainage with culture of