Appraisal of Anterior Approach in Right Hepatic Lobectomy

Kim, Hong Jin; Lim, Myeung Kook; Son, Dae Ho; Kwun, Koing Bo

Abstract

BACKGROUND/AIMS: Despite recent advances in liver surgery, complication and mortality rate in hepatectomy are still high compared to other abdominal surgeries. Intraoperative stress such as bleeding, vascular occlusion, excessive mobilization and prolonged operation time is the most important factor in postoperative complications. Anterior approach avoiding hepatic mobilization and vascular occlusion in right hepatic lobectomy is a useful method for decreasing intraoperative stress. We investigated the effectiveness of anterior approach in right hepatic lobectomy.
METHODS
We studied 33 cases of right hepatic lobectomy for malignant tumor between January 1993 and June1997. Thre were 13 cases of Anterior approach (group A) and 20 cases of classic right hepatic lobectomy (group B). We analyzed liver function test, arterial ketone body ratio(AKBR), operation time, blood transfusion during operation, hospital stay, and postoperative complications.
RESULTS
Total bilirubin levels at first and seventh postoperative days were 2.1+/-0.6mg/dl, 0.9+/-0.2mg/dl in group A and 2.7+/-1.3mg/dl, 1.0+/-0.3mg/dl in group B. AST were 189+/-65.3 IU/L, 43+/-13.5 IU/L in group A and 325+/-67.8 IU/L, 51+/-18.2 IU/L in group B. ALT were 169+/-30.5 IU/L, 52+/-17.4 IU/L in group A and 295+/-70.3 IU/L, 52+/-16.6 IU/L in group B. AKBR at intraoperative and immediate postoperative period were 0.58+/-0.06, 0.62+/-0.03 in group A and 0.38+/-0.04, 0.40+/-0.08 in group B. Neither operation time (in group A : 380.5+/-61.1 minutes, in group B : 342.9+/-54.8 minutes), transfusion volume during operation (group A : 1222+/-802cc, group B : 1410+/-476cc), nor hospital stay (group A : 22.8+/-3.5 days, group B : 19.1+/-1.4 days) were different between the two groups. Complication rate was lower in group A compared to that of group B (30.8% vs. 40.0%). There was 1 mortality in group B and no mortality in group A.
CONCLUSIONS
It is suggested that right hepatic lobectomy through the anterior approach is a useful surgical procedure to reduce intraoperative surgical stress and postoperative complications.