Liver resection




M Liver resection




1. Introduction

Patients presenting for hepatic surgery may have primary or metastatic tumors from gastrointestinal and other sources. Liver function may be entirely normal in these patients. Hepatocellular carcinoma is common in men older than 50 years and is associated with chronic, active hepatitis B and cirrhosis. Although most major liver resections can be performed by a transabdominal approach, some surgeons prefer a thoracoabdominal approach. The liver is transected by blunt dissection using the Cavitron ultrasonic suction aspirator and argon beam laser coagulator. Newer ablation devices include hydro jet and ultrasonic pulses.


As the principles and techniques of hepatic surgery have evolved, the overall mortality and morbidity rates have improved considerably. Because the normal liver can regenerate, it is possible to resect the right or left lobe along with segments of the contralateral lobe. In patients with cirrhosis, the regeneration process is limited; thus, uninvolved liver should be preserved.



2. Preoperative assessment

The following preoperative considerations are for patients without hepatic cirrhosis:



a) History and physical examination: These are as indicated by the patient’s history and medical condition.

b) Patient preparation
(1) Laboratory tests: Complete blood count, coagulation profile, liver function test, albumin, creatinine, blood urea nitrogen, blood sugar, bilirubin, and electrolytes are obtained. Perform other tests as indicated by the history and physical examination.

(2) Diagnostic tests: Chest radiography, ultrasonography, computed tomography, and magnetic resonance imaging are used as indicated by the history and physical examination.

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Dec 2, 2016 | Posted by in ANESTHESIA | Comments Off on Liver resection

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