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Abstract
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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Article info
Footnotes
☆Presented at the Twelfth Annual Meeting of the Society for Surgery of the Alimentary Tract, Atlantic City, New Jersey, June 19–20, 1971.
Identification
Copyright
© 1972 Published by Elsevier Inc.
