caa a22 4500 477035558 CHVBK 20180405111304.0 cr unu---uuuuu 170330e19960301xx s 000 0 eng 10.1007/s002689900050 doi (NATIONALLICENCE)springer-10.1007/s002689900050 Anterior Approach for Difficult Major Right Hepatectomy [Elektronische Daten] [Edward C.S. Lai, Sheung-Tat Fan, Chung-Mau Lo, Kent-Man Chu, Chi-Leung Liu] Abstract. In selected patients with huge right hepatic tumors that had infiltrated the surrounding structures, injudicious mobilization of the liver before transection, as in the conventional manner, may result in excessive bleeding, prolonged ischemia from rotation of the hepatoduodenal ligament, and spillage of cancer cells into the systemic circulation. Alternatively, the "anterior” approach, which involves initial completion of the parenchymal transection before the right hepatic lobe is mobilized, can be adopted for these patients with difficult right hepatic tumors. After hilar control of the inflow vessels, liver parenchyma was transected using an ultrasonic dissector until the anterior surface of the inferior vena cava is exposed. The right hepatic lobe is then mobilized laterally by securing all venous tributaries, including the right hepatic vein. The prospective data of 25 patients who had major right hepatectomy using the "anterior” approach were compared with data from 34 patients who had their operation performed in the conventional manner. Despite the facts that larger tumors (: p < 0.004), more extrahepatic structures ( p < 0.05), and the caudate lobes ( p < 0.03) were resected, the amount of perioperative blood transfusion, fluid replacement, and outcome between the two groups of patients were comparable. There were three hospital deaths, among which one could be attributed to an intraoperative catastrophe during hepatectomy using the conventional approach. The "anterior” approach is a safe, effective option for selected patients undergoing complicated major right hepatectomy. 1996 by the Société Internationale de Chir, ugie Lai Edward C.S. Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut Fan Sheung-Tat Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut Lo Chung-Mau Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut Chu Kent-Man Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut Liu Chi-Leung Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut https://doi.org/10.1007/s002689900050 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689900050 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lai Edward C.S. Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut NATIONALLICENCE 700 1- Fan Sheung-Tat Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut NATIONALLICENCE 700 1- Lo Chung-Mau Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut NATIONALLICENCE 700 1- Chu Kent-Man Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut NATIONALLICENCE 700 1- Liu Chi-Leung Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, HK aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer