A Combined 'Hanging Liver Maneuver' and 'Intrahepatic Extra-Glissonian Approach' for Anatomical Right Hepatectomy: Technique Standardization, Results, and Correlation With Portal Pedicle Anatomy
| Autor: | Vagner Birk Jeismann, Fabio F. Makdissi, Fabricio Ferreira Coelho, Bruno H Mattos, Jaime Arthur Pirola Kruger, Paulo Herman |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
hanging liver maneuver
anatomy RD1-811 intrahepatic glissonian approach medicine.medical_treatment Liver resections 03 medical and health sciences 0302 clinical medicine hepatectomy Blood loss Methods Medicine business.industry Operative mortality Anatomy Perioperative Combined approach portal pedicle 030220 oncology & carcinogenesis Operative time 030211 gastroenterology & hepatology Surgery Hepatectomy business Hospital stay colorectal liver metastasis |
| Zdroj: | Frontiers in Surgery Frontiers in Surgery, Vol 8 (2021) |
| ISSN: | 2296-875X |
| Popis: | Background: The hanging liver maneuver and intrahepatic extra-Glissonian approach are distinct modalities to facilitate safe anatomical liver resections. This study reports a standardized combination of these techniques focusing on safety, results and correlation with portal pedicle anatomy in oncological patients.Method: Combined hanging liver maneuver and intrahepatic extra-Glissonian approach for anatomic right hepatectomy was described stepwise. Portal pedicle anatomy was correlated with the Glissonian approach failure and complications. Clinical characteristics of patients, perioperative outcomes, short and long-term survival rates were analyzed.Results: Thirty colorectal liver metastases patients submitted to the combined approach were evaluated. Anatomical variations of the right portal pedicle were present in 26.6%. Hanging liver maneuver was feasible in 100%, and Glissonian approach in 96.7% despite portal pedicle variations. Mean operative time was 326 min. Mean blood loss was 507 ml. Mean hospital stay was 8 days. There was no 90-day operative mortality and no significant morbidity. Oncological surgical margins were free. Overall and disease-free 5-year survival were 59 and 37%.Conclusion: Regardless of frequent anatomical variations of the right portal pedicle, the hanging liver maneuver, and intrahepatic extra-Glissonian approach can be combined, being useful for anatomical right hepatectomies in a safe and reproducible way in most patients. |
| Databáze: | OpenAIRE |
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