Open AccessFuture Liver remnant: A challenge in liver resection surgery
Author(s) -
Sujan Regmee,
TY Tamang,
DK Maharjan,
Suraj Shrestha,
Pratima Thapa
Publication year - 2016
Publication title -
journal of society of surgeons of nepal
Language(s) - English
Resource type - Journals
eISSN - 2392-4772
pISSN - 1815-3984
DOI - 10.3126/jssn.v18i3.15309
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , resection , liver function , hepatectomy , surgery , decompensation , liver failure , decompression , liver cancer , general surgery
and Objective: The frontiers of liver resection are expanding. Future Liver Remnant; its volume, function and complication have a predictive value in post resection outcome including post resection liver failure. This study is directed to discuss the issues related to future liver remnant.Objective: To discuss issues related to Future Liver Remnant in patients planned for major liver resectionMaterials and Methods: Data of patients admitted for liver resection at Kathmandu Medical College Teaching Hospital, Surgical Unit III with varied diagnosis, were collected prospectively over a period of 1 year. In our non transplant center, Future Liver Remnant was managed with varying methods. Of the 12 liver resections, 3 prototype cases with different FLR issues are discussed in this study.Results: The first case had issue related to the volume of the liver remnant for which she underwent a portal vein ligation followed by resection (after adequate volume increase) in the second surgery. The second case was a Hepatocellular Carcinoma with CTP 8 cirrhosis. Despite adequate liver volume, decision for liver resection was delayed due to possible postoperative decompensation. The third patient was a Hilar cholangiocarcinoma with obstructive jaundice. Biliary decompression (PTBD) was performed. However, inadequate fall in bilirubin caused dilemma for liver resection. Despite the dilemma, all 3 cases underwent liver resection with no postoperative liver failure.Conclusion: Issues related to the volume and function of future liver remnant in patient undergoing liver resection should be adequately addressed by various pre operative, intra operative, and post operative measures.