scholarly journals Hanging manuever in liver trauma

2010 ◽  
Vol 57 (4) ◽  
pp. 53-56
Author(s):  
Vladimir Djukic ◽  
Aleksandar Karamarkovic ◽  
Dejan Radenkovic ◽  
Pavle Gregoric ◽  
Vasilije Jeremic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Liver Resection ◽  
Hepatic Vein ◽  
Intensive Therapy ◽  
Trauma Surgery ◽  
Liver Trauma ◽  
Hepatic Veins ◽  
Trauma Patients ◽  
Suture Materials ◽  
Hanging Maneuver

The philosophy of aggressive surgical approach, its complete implementation in liver trauma surgery did not appear efficient. No matter of permanenent development of diagnostic imaging methods, anesthesia, intensive therapy, medical technology and suture materials, operational theater and operative techniques, major liver resections in trauma had mortality rate up to 60%. With introduction of computerized tomography ( CT,1981) in everyday clinical praxis and with better evaluation of trauma patients, the whole approach to liver trauma patient has been redesigned. Based on AAST - OIS classification, almost 70% of traumatized with grade I,II and III should be treated non - operatively, hospitally, with repeating FAST (focused abdominal ultrasound in trauma) and abdominal CT scans. The rest of traumatized patients, with grade IV and V injuries of juxtahepatic structures demand complexive surgical treatment. The modalities of surgical treatment depend on trauma mechanisms, extensivity, anatomical localization and affection of vascular structures. Hanging Manuevr- the Method of French surgeon Belghiti bases on anterior approach in liver resection is a try for fast solution for fatal bleeding in liver trauma. It consists of placing the elastic cord throughout the anterior surface of VCI or ligamentum venosusm, of upper end of the cord is located in superior part of VCI where hepatic veins are emerging. Lower end of the cord is located in subhepatic part of VCI between 3 Glisonian pedicles. Concerning hepatic veins liver is divided in 3 sections, which derives blood in right hepatic vein RHV, middle hepatic vein MHV and left hepatic vein LHV. Belghiti proposed the usage of hanging maneuver when resecting the right liver, while the cord is placed throughout retrohepatic VCI, lower end between elements of Glisonian pedicle and upper end between hepatic veins. Complications like bleeding from caudal veins are minimal, then speed in liver resection in hemodynamic unstable and ishemic patient, defects like bleeding because compressing tapes or lesions IVC tile mobilazion of liver for conventional resection.

scholarly journals Ex Vivo Liver Resection and Autotransplantation as Surgical Option for Zone II–III Leiomyosarcoma of IVC: A Case Report and Literature Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Tuerhongjiang Tuxun ◽  
Tao Li ◽  
Shadike Apaer ◽  
Yi-Biao He ◽  
Lei Bai ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hepatic Vein ◽  
Ex Vivo ◽  
Three Dimensional ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Hepatic Recurrence ◽  
Chiari Syndrome ◽  
Zone Ii

We report the first documented case of leiomyosarcoma at zone II-III of inferior vena cava with thrombi in three hepatic veins undergoing ex vivo liver resection and autotransplantation (ELRA) and hepatic veins thrombectomy. A 33-year-old female patient presented with abdominal distention and lower extremities edema. Abdominal wall varicosis and shifting dullness were positive on physical examination. Her liver function was classified as Child-Pugh B and a solid tumor at retro-hepatic vena cava extending to right atrium with thrombi in three hepatic veins were confirmed. The diagnosis of leiomyosarcoma with Budd-Chiari syndrome was highly suspected with preoperative ultrasound, echocardiogram, CT scan, and three-dimensional reconstruction. A zone II-III leiomyosarcoma of IVC origin was confirmed at surgery and ex vivo liver resection and autotransplantation, and hepatic vein thrombectomy with atrial reconstruction were performed under cardiopulmonary bypass (CPB). Operative time, anhepatic time, and CPB time were 12 h, 128 min, and 84 min, respectively. The patients experienced post-operative liver dysfunction and was cured with conservative therapy. Hepatic recurrence two years after surgery was managed with radiofrequency. The patient was alive with liver metastasis three years after surgery. Despite being regarded as an extremely aggressive procedure, ELRA could be considered in the treatment of advanced leiomyosarcoma with Budd-Chiari syndrome and hepatic vein thrombi.

scholarly journals Surgical treatment in hepatic trauma: factors associated with hospitalization time

2021 ◽  
Vol 48 ◽  
Author(s):  
PAULA DE OLIVEIRA TRINTINALHA ◽  
EMANUELLA ROBERNA INÁ CIRINO ◽  
RENATA FERNANDA RAMOS MARCANTE ◽  
GABRIEL RAMOS JABUR ◽  
PATRÍCIA LONGHI BUSO
Keyword(s):  
Surgical Treatment ◽  
Hospital Stay ◽  
Penetrating Trauma ◽  
Length Of Hospital Stay ◽  
Hemodynamic Instability ◽  
Liver Trauma ◽  
University Hospital ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Firearm Injury

ABSTRACT Objective: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. Methods: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. Results: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. Conclusions: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.

scholarly journals How Far Can We Go with Laparoscopic Liver Resection for Hepatocellular Carcinoma? Laparoscopic Sectionectomy of the Liver Combined with the Resection of the Major Hepatic Vein Main Trunk

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Zenichi Morise ◽  
Norihiko Kawabe ◽  
Hirokazu Tomishige ◽  
Hidetoshi Nagata ◽  
Jin Kawase ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hepatic Vein ◽  
Laparoscopic Liver Resection ◽  
Operating Time ◽  
Hepatic Veins ◽  
Peripheral Part ◽  
Main Trunk ◽  
Hepatocellular Carcinomas ◽  
Vein Resection ◽  
Major Hepatic Vein

Although the reports of laparoscopic major liver resection are increasing, hepatocellular carcinomas (HCCs) close to the liver hilum and/or major hepatic veins are still considered contraindications. There is virtually no report of laparoscopic liver resection (LLR) for HCC which involves the main trunk of major hepatic veins. We present our method for the procedure. We experienced 6 cases: 3 right anterior, 2 left medial, and 1 right posterior extended sectionectomies with major hepatic vein resection; tumor sizes are within 40–75 (median: 60) mm. The operating time, intraoperative blood loss, and postoperative hospital stay are within 341–603 (median: 434) min, 100–750 (300) ml, and 8–44 (18) days. There was no mortality and 1 patient developed postoperative pleural effusion. For these procedures, we propose that the steps listed below are useful, taking advantages of the laparoscopy-specific view. (1) The Glissonian pedicle of the section is encircled and clamped. (2) Liver transection on the ischemic line is performed in the caudal to cranial direction. (3) During transection, the clamped Glissonian pedicle and the peripheral part of hepatic vein are divided. (4) The root of hepatic vein is divided in the good view from caudal and dorsal direction.

Selective Hepatic Vascular Exclusion versus Pringle Maneuver in Partial Hepatectomy for Liver Hemangioma Compressing or Involving the Major Hepatic Veins

2014 ◽  
Vol 80 (3) ◽  
pp. 236-240 ◽  
Author(s):  
Yuan Yang ◽  
Ling-Hao Zhao ◽  
Si-Yuan Fu ◽  
Wan Yee Lau ◽  
Eric C. H. Lai ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Hepatic Vein ◽  
Pringle Maneuver ◽  
Hepatic Veins ◽  
Parenchymal Transection ◽  
Liver Hemangioma ◽  
Vascular Exclusion ◽  
Significant Difference ◽  
Hepatic Vascular Exclusion

Massive blood loss remains a problem during resection for giant liver hemangioma. This present study was designed to compare selective hepatic vascular exclusion (SHVE) versus Pringle maneuver in surgery for liver hemangioma compressing the major (right, middle, or left) hepatic veins. From January 2003 to December 2011, 589 consecutive patients with hemangioma underwent liver resection in our department, and 273 patients had their tumors compressing at least one of the three major hepatic veins (right, middle, or left). Either SHVE (n = 120 patients) or Pringle maneuver (n = 153 patients) was used to minimize blood loss during resection. Data regarding the intraoperative and postoperative courses of these patients were retrospectively analyzed. There was no significant difference between the two groups of patients regarding age, sex, tumor size, types of hepatectomy, and extent of tumor involvement of the major hepatic veins. Intraoperative blood loss, transfusion requirements, and transfusion volume were significantly less in the SHVE group ( P < 0.01). For the Pringle group, major hepatic veins were lacerated in 19 patients during hepatic parenchymal transection. For the SHVE group, a major hepatic vein was lacerated during extrahepatic dissection of the hepatic vein in two patients and during hepatic parenchymal transection in 14 patients. SHVE was more efficacious in minimizing intraoperative bleeding during liver resection for hemangiomas compressing the major hepatic veins. It prevented intraoperative major bleeding and air embolism and significantly decreased postoperative liver failure and in-hospital mortality.

A RARE CASE OF COMPLICATED LIVER ABSCESS WITH MIDDLE HEPATIC VEIN THROMBOSIS: A CASE REPORT AND REVIEW OF LITERATURE

2021 ◽  
pp. 1-2
Author(s):  
V.P.S. Punia ◽  
Praveen Raman Mishra ◽  
Shaavi Mittal ◽  
Akash Bharti ◽  
Prem Kumar ◽  
...  
Keyword(s):  
Liver Abscess ◽  
Hepatic Vein ◽  
Middle Hepatic Vein ◽  
Amoebic Liver Abscess ◽  
Hepatic Veins ◽  
Review Of Literature ◽  
Extraintestinal Manifestation ◽  
Vein Thrombosis ◽  
Histolytica Infection ◽  
Life Threatening

In developing countries Amoebic liver abscess is commonly encountered disease and it’s also the commonest extraintestinal manifestation of Entamoeba histolytica infection. Usual complication of Amoebic liver abscess arises due to collection of pus in various cavities, like in peritoneal cavity following perforation, in the pleural cavity which is known as empyema thoracis, and rarely it is complicated by life threatening conditions such as venous extension of the disease involving the hepatic veins and IVC, with only few cases reported. Here we describe a case of amoebic liver abscess extending across middle hepatic vein.

Anatomy of the Middle Hepatic Vein Tributaries to Promote Safer Hepatic Vein-Guided Liver Resection

2021 ◽  
Author(s):  
Satoshi Ogiso ◽  
Satoru Seo ◽  
Takamichi Ishii ◽  
Shinya Okumura ◽  
Tomoaki Yoh ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hepatic Vein ◽  
Middle Hepatic Vein

scholarly journals Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1667
Author(s):  
Janett Kreutziger ◽  
Margot Fodor ◽  
Dagmar Morell-Hofert ◽  
Florian Primavesi ◽  
Stefan Stättner ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Liver Injury ◽  
Injury Severity ◽  
Severe Form ◽  
Liver Trauma ◽  
University Hospital ◽  
Hepatic Insulin Resistance ◽  
Trauma Patients ◽  
Stress Hyperglycemia ◽  
Glucose Levels

Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury.

scholarly journals Hepatic Alveolar Echinococcosis: the Possibilities of Ultrasonographyin the Planning of Surgical Operation

2017 ◽  
pp. 32-48
Author(s):  
O. I. Ashivkina
Keyword(s):  
Liver Resection ◽  
Alveolar Echinococcosis ◽  
New Technologies ◽  
Statistical Significance ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Surgical Operation ◽  
Curative Therapy ◽  
Specificity And Sensitivity ◽  
Ct And Mri

Alveolar echinococcosis (AE) is a rare anthropozoonotic parasitic disease, which can affects the liver, lungs and other organs. R0-radical liver resection is the sole curative therapy for the patients with AE. Size of the parasitic foci, distant dissemination, and involvement of main liver vessels – all this information allows the surgeon to make the right decision about practicability and volume of operation. Formerly, ultrasonography (US) was not method of choice for the qualitative pre-operative diagnostic of AE. Nevertheless nowadays development of new technologies allows US to be an equal to CT and MRI.The aim:to estimate the possibilities of US in the planning of surgery in patients with AE.Materials and methods.The data of 64 patients who were undergone complete liver resection or reduction surgery in A.V. Vishnevsky Surgery Institute in period from January 2008 to December 2016 we respectively analyzed. Specificity and sensitivity of US, CT and MRI were analyzed and ROC-curves were constructed. Statistical significance was calculated using Chi-square.Results.The efficiency of US was significantly comparable to CT and MRI when we analyzed the involved of porta hepatis, vena cava, hepatic veins. Assessment of involvement of liver arteries and vena porta was not statistical significant.Conclusion.Accumulated experience of A.V. Vishnevsky Surgery Institute shows the possibility of qualitative preoperationUS evaluation of AE-lesion, which has to include assessment of distant dissemination and involvement of the liver main vessels. In a big surgical hospitals, which has an experience of AE treatment, pre-operative US can become the method of choice in planning of surgical operation. 

Sign in / Sign up

Export Citation Format

Share Document