HEPATIC RESECTION IN CIRRHOTIC PATIENTS, is it feasible?
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Hepatic resection is now an established line of treatment for many liver diseases. The main problem of hepatic resection in cirrhotics is the higher intraoperative and perioperative mortality and morbidity rates especially if associated with compromized hepatic functions. Now successful hepatic resections can be done in cirrhotics after good preoperative preparation and good selection of the patients. In this work, fourteen patients with cirrhotic liver undenvent hepatic resections. The indications were primary hepatocellular carcinoma in 8 patients (57%), metastases from colorectal carcinoma in 5 patients (WA), and hydatid cyst in one patient (7%). Formal right hepatectomy was done in 7 patients (50%), left hepatectomy was done in 5 patients (36%), limited liver resection in one patient (7%), and right trisectionectomy in another one (7%). The technique adopted in all cases was bilateral subcostal incision, dissection of the hepatic pedicle and ligation and division of the appropriate structures, finger fracture technique for division of the parenchyma of the liver and ligation of the hepatic veins from within the liver parenchyma. Pringle's manoeuver was resorted to in 3 patients. All the patients who had right or left hepatectomy showed depressed liver functions that returned to normal in most of them within 5 weeks. We had one case of post-operative mortality due to bleeding. Three patients passed into liver cell failure due to extended resection for hepatocellular carcinoma, two of them showed gradual improvement on medical treatment and one passed to death. Two patients developed biliary fistulae which closed spontaneously. One case developed multiple metastases in the left lobe after resection of the right lobe for multiple rectal metastases. This study concluded that successful hepatic resection can be achieved in cirrhotics with acceptable mortality and morbidity rates after good preoperative preparation and good selection of the patients.