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One Hundred Consecutive Hepatectomies in Cirrhotic and Noncirrhotic Patients

Dominique Franco, MD; Claude Smadja, MD; Jonathan L. Meakins, MD; Andrew Wu, MD; Laurent Berthoux, MD; Didier Grange, MD

Arch Surg. 1989;124(9):1033-1037.

Abstract
• Liver resection for a neoplasm was performed in 100 patients between 1979 and 1987. There were 43 hepatocellular carcinomas (70% of them arising in patients with cirrhosis), 28 metastases from colorectal cancers, 20 benign tumors, and 9 miscellaneous tumors. Forty-nine patients had a major liver resection, 36 a segmentectomy, and 15 a nonanatomic liver resection. Great care was taken to avoid intraoperative and postoperative bleeding, including late ligation of the hepatic vein, the use of Kelly fracture and resorbable clips for hemostasis of transection planes in 74 patients, and temporary clamping of the portal pedicle in 22. Drainage of the abdomen was avoided in 21 patients to prevent ascitic leakage to decrease the postoperative hospital stay. Operative mortality was 1%. There were eight major complications, including one bile leak, one subphrenic abscess, and three subphrenic hematomas. The use of resorbable clips significantly reduced operative time and transfusion requirements. In patients with cirrhosis, temporary clamping of the hepatic pedicle significantly decreased blood loss. Avoiding drainage significantly decreased the postoperative hospital stay.

(Arch Surg. 1989;124:1033-1037)

Author Affiliations
From the Department of Research on Surgery of the Liver and Portal Hypertension, Hôpital Paul Brousse, Villejuif (Dr Franco), Hôpital Bicêtre, Le Kremlin Bicêtre (Dr Smadja), and Hôpital Louise Michel, Evry (Drs Meakins, Wu, Berthoux, and Grange), France. Dr Meakins is now with the Department of Surgery, McGill University, Montreal, Canada. Dr Wu is now with the Department of Surgery, Walton Hospital, Liverpool, England.

Footnotes
Accepted for publication December 29, 1988.

Reprint requests to Hôpital Paul Brousse, 94804 Villejuif Cédex, France (Dr Franco).

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