Lobe Hepatectomy Research Articles

Selection and outcome of living donors for adult to adult right lobe transplantation.

The shortage of cadaveric livers has sparked an interest in adult-to-adult living donor transplantation. Right lobe donor hepatectomy is frequently required to obtain a graft of adequate size for adult recipients. Careful donor selection is necessary to minimize complications and assure a functional graft. A four-step evaluation protocol was used for donor selection and satisfactory results of all tests in each step were required before proceeding to the next. Donors were selected based on a battery of laboratory studies chosen to exclude unrecognized infection, liver disease, metabolic disorders, and conditions representing undue surgical risk. Imaging studies included ultrasonography, angiography, magnetic resonance imaging, and intraoperative cholangiography and ultrasonography. The information obtained from liver biopsy was used to correct the estimated graft mass for the degree of steatosis. From March 1998 to August 1999, 126 candidates were evaluated for living donation. A total of 35 underwent donor right lobectomy with no significant complications. Forty percent of all donors that came to surgery were genetically unrelated to the recipient. A total of 69% of those evaluated were excluded. ABO incompatibility was the primary reason for exclusion after the first step (71%) and the presence of steatosis yielding an inadequate estimated graft mass after the second step (20%). Donor selection limits the application of living donor liver transplantation in the adult population. Unrelated individuals increase the size of the donor pool. Right lobe hepatectomy can be performed safely in healthy adult liver donors. Preoperative liver biopsy is an essential part of the evaluation protocol, particularly when the estimated graft mass is marginal.

Right adrenal hematoma following hepatectomy.

We present the findings and possible causes in three cases of postoperative adrenal hematomas. In 16 cases of 45 consecutive patients, following segmental right or left lobe hepatectomy, CT was performed in order to evaluate possible fluid collection or other complications. In all cases imaging findings and a correlation with preoperative CT scans were done. Follow up CT examinations were also reviewed. In three cases solid suprarenal masses with attenuation values consistent with adrenal hematomas were found. Preoperative scans at the same level indicated normal adrenal glands. Follow-up scans revealed the hematoma, stable in size, for up to 12 weeks, although lower attenuation values were evident. Right adrenal hematoma is a possible postoperative complication following hepatectomy; if it remains stable in size, it can be left alone.

Surgical Resection for Management of Renal Cancer with Hepatic Involvement

Purpose More than 900 patients who underwent hepatic resections were reviewed to identify those whose liver resections were due to involvement by renal cell carcinoma. Materials and Methods Three patients with direct hepatic extension of the renal cell cancer underwent radical nephrectomy with en bloc partial hepatectomy, while 1 with a metachronous recurrence 3 years after nephrectomy underwent right triple lobe hepatectomy. There were no postoperative complications. Results Of the en bloc resections 2 showed sarcomatoid features on histopathological examination. These patients experienced rapid disease progression and died. The remaining 2 patients with typical clear cell carcinoma have no evidence of disease. Conclusions Experience with these 4 patients has demonstrated that hepatic resection is technically feasible and associated with acceptable morbidity rates. Surgical management should be considered in patients with the uncommon presentation of renal cell carcinoma and localized hepatic involvement.

Actinomycosis of the liver: Report of a case with special reference to liver function tests

A twenty year old man was successfully operated on for actinomycosis of the liver with left lobe hepatectomy and intensive antibiotic therapy. Abnormalities in the liver function tests included an elevated gamma globulin level, zinc sulfate turbidity test, thymol turbidity test, alkaline phosphatase, bromosulfalein retention, and moderate impairment of other liver functions. The liver function tests were of even greater significance both for diagnosis and as an index of successful treatment.