Anterior approach for right hepatectomy using liver hanging maneuver in severe blunt liver trauma

Abstract

Objective To evaluate the application value of anterior approach right hepatectomy using the liver hanging maneuver for severe blunt liver trauma. Methods Clinical data of 63 patients with severe blunt liver trauma undergoing right hepatectomy in our hospital from January 2011 to January 2017 were retrospectively analyzed. Among them, 31 patients received anterior approach right hepatectomy (anterior approach group, 31 cases) while the others did conventional right hepatectomy(conventional approach group , 32 cases). Clinical data, intraoperative blood loss, postoperative alanine transaminase (ALT) at POD3, postoperative morbidity and mortality in both groups were analyzed and compared. Results There were eight surgical deaths, one in the anterior approach group and seven in the conventional approach group. All the 31 cases underwent anterior approach right hepatectomy successfully using the liver hanging maneuver. The mean intraoperative blood loss(768±231)ml vs. (1 264±1 248)ml(P<0.05), postoperative hepatic function ALT value at POD3(155±89)U/L vs. (689±67)U/L (P<0.05), postoperative morbidity and mortality of the anterior approach group were markedly superior to conventional approach group (12.9% vs. 34.4%, 3.2% vs. 21.9%, all P<0.05). Conclusions Anterior approach right hepatectomy using the liver hanging maneuver has advantages of decreased intraoperative blood loss, less hepatic function compromise, reduced postoperative morbidity and mortality compared to conventional approach right hepatectomy in cases of severe right liver blunt trauma. Key words: Wounds and injuries; Hepatectomy; Liver hanging maneuver; Retrohepatic avascular tunnel