Ann Hepatobiliary Pancreat Surg.  2023 Aug;27(3):258-263. 10.14701/ahbps.22-130.

Surgery for symptomatic hepatic hemangioma: Resection vs. enucleation, an experience over two decades

• Ghosh NK
• R R
• Singh A
• Malage S
• Sharma S
• Kumar A
• Kumar Singh R
• Behari A
• Kumar A
• Saxena R

• KMID: 2545719
• DOI: http://doi.org/10.14701/ahbps.22-130

Abstract

Backgrounds/Aims
Hemangiomas are the most common benign liver lesions; however, they are usually asymptomatic and seldom require surgery. Enucleation and resection are the most commonly performed surgical procedures for symptomatic lesions. This study aims to compare the outcomes of these two surgical techniques.
Methods
A retrospective analysis of symptomatic hepatic hemangiomas (HH) operated upon between 2000 and 2021. Patients were categorized into the enucleation and resection groups. Demographic profile, intraoperative bleeding, and morbidity (Clavien-Dindo Grade) were compared. Independent t-test and chi-square tests were used for continuous and categorical variables respectively. p-value of < 0.05 was considered significant.
Results
Sixteen symptomatic HH patients aged 30 to 66 years underwent surgery (enucleation = 8, resection = 8) and majority were females (n = 10 [62.5%]). Fifteen patients presented with abdominal pain, and one patient had an interval increase in the size of the lesion from 9 to 12 cm. The size of hemangiomas varied from 6 to 23 cm. The median blood loss (enucleation: 350 vs. resection: 600 mL), operative time (enucleation: 5.8 vs. resection: 7.5 hours), and postoperative hospital stay (enucleation: 6.5 vs. resection: 11 days) were greater in the resection group (statistically insignificant). In the resection group, morbidity was significantly higher (62.6% vs. 12.5%, p = 0.05), including one mortality. All patients remained asymptomatic during the follow-up.
Conclusions
Enucleation was simpler with less morbidity as compared to resection in our series. However, considering the small number of patients, further studies are needed with comparable groups to confirm the superiority of enucleation over resection.

Keyword

Hemangioma; Liver; Hepatectomy; Enucleation; Morbidity

Figure

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  Fig. 1 Contrast-enhanced computed tomography of the liver showing hemangiomas in different segments of the liver. (A) Segment VI, (B) segment II, (C) segments VI and VII, and (D) segments IVb and V.

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  Fig. 2 Intraoperative pictures. (A) Ligation of the feeding vessel, (B) creation of a plane between the lesion and liver parenchyma.

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  Fig. 3 (A) A figure post-enucleation showing a preserved hepatic vein branch; (B) enucleated specimens from multiple segments.

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