Hepatic resection is now an established line of treatment for many liver diseases. The
main problem of hepatic resection in cirrhotics is the higher intraoperativc 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 underwent hepatic resections. The indications were primary hepatocellular carcinoma in
8 patients (57%), metastases from colorectal carcinoma in 5 patients (36%), and hydatid cyst
in one patient (7%). Formal right hepatcctomy was done in 7 patients (50%), left hepatectomy
was done in 5 patients (36%), limited liver resection in one patient (7%), and right
triscctionectomy 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. |
