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lgin Özden, MD; Ali Emre, MD; Aydn Alper, MD; Mehtap Tunac, MD; Koray Acarl, MD; Orhan Bilge, MD; Yaman Tekant, MD; Orhan Arogul, MD

Arch Surg. 2000;135:978-981.

Background  Elective surgery for liver hemangiomas is still controversial.

Hypothesis  Long-term results show that elective surgery for liver hemangiomas is safe and effective.

Setting  A tertiary care university hospital in Istanbul, Turkey.

Patients  Forty-two patients underwent surgery for liver hemangiomas between January 1988 and December 1998; 41 were symptomatic. The primary indications for surgery were abdominal pain in 33 patients, diagnostic uncertainty in 6, and enlargement in 3. The median largest dimension of the major lesion was 10 cm (range, 7-45 cm).

Main Outcome Measures  (1) Patients' assessment of the effects of surgery on preoperative symptoms, (2) determination of whether any other pathological conditions were missed in the preoperative evaluation, (3) operative mortality and morbidity, and (4) recurrences.

Design  Retrospective cohort study.

Results  Enucleation was the most frequent operation (33 patients). Hospital mortality and morbidity were 2.4% (bleeding from the biopsy site on a lesion evaluated as inoperable at laparotomy; 1 patient) and 12% (5 patients), respectively. Thirty-three patients could be followed up for a median of 53 months (range, 6-135 months). Of the 32 preoperatively symptomatic patients, surgery was successful in symptom control in 28 (88%) (complete resolution or significant amelioration). No other cause of pain could be identified during follow-up in the other patients. Control ultrasonography revealed no recurrences.

Conclusions  Elective surgery is indicated in a small subset of patients with hemangiomas because of abdominal pain, enlargement, and diagnostic uncertainty. The results of surgery in symptom control are gratifying in approximately 90% of patients. Recurrences are rare. Enucleation can be performed rapidly and safely in most patients and should be preferred to resection.

From the Department of General Surgery, Hepatopancreatobiliary Surgery Unit (Drs Özden, Emre, Alper, Acarl, Tekant, and Aroul), and the Department of Radiology (Dr Tunac), Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.

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