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Right hemihepatectomy was performed over period of a few months in ten patients as a straight or deferred emergency or as secondary treatment. Six of the patients operated on are alive and well; the remaining four patients died, not as a result of the operation, but in each case because of an associated lesion, especially severe craniocerebral trauma with immediate coma. In four cases the hepatic lesions included a tear of the inferior vena cava, a source of hemorrhage which proved uncontrollable by the classic methods: two of these patients are cured, and two died, but they also had a craniocerebral lesion.
These facts encourage us to propose right hemihepatectomy as a method of treatment of severe lesions of the right lobe of the liver. Whereas the socalled “anatomic” hepatectomy is indicated for the excision of hepatic tumors, we recommend for the management of liver trauma a more rapid, less anatomic exeresis, namely, hepatectomy by finger fracture, limiting the pedicle clamping time to fifteen minutes (this time can be extended to as much as thirty minutes under moderate [35 °F] hypothermia).
Hemihepatectomy for trauma to the right lobe of the liver is justified only in very special cases: bursting of the right hepatic lobe, uncontrollable hemorrhage resulting from a tear to the right suprahepatic vein or an injury to the inferior vena cava, and complications secondary to rupture of the liver. It is indicated when life cannot be saved by lesser procedures, which should be ascertained beforehand by all possible means.
In the hands of experienced surgeons, hemihepatectomy should further lower the mortality rate from severe liver trauma, although the prognosis may depend on associated lesions.
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☆Presented at the Twelfth Annual Meeting of the Society for Surgery of the Alimentary Tract, Atlantic City, New Jersey, June 19–20, 1971.
© 1972 Published by Elsevier Inc.