A Case Report of Extracorporeal Hepatectomy of the Medial and Anterior Segments for Liver Tumor

Katsuhiro Tamura, Seiji Yano, Koji Hashimoto, Haruhiko Nagami, Masayuki Itakura, Tohru Ishida, Yasushi Inoue, Masahisa Nakagawa, Akira Nakase

First Department of Surgery, Shimane Medical University

Extracorporeal resection of the medial and anterior segments with autotransplantation of the posterior segment was performed after in situ right trisegmentectomy for a liver tumor which involved the middle hepatic vein and was close to the right and left hepatic veins and large branches of the intrahepatic portal vein. This procedure has the advantage of less bleeding than in situ middle bisegmentectomy and of being easier than the various ex situ or in situ procedures with an ahepatic period after total hepatic resection or total vascular exclusion. In the present patient, 3,600 ml of blood was transfused in the perioperative period. The arterial ketone body ratio was no longer in the dangerous zone immediately after resupplying of the blood of the autotransplanted segment of the liver, and remained normal from the first postoperative day. The patient had recovered from hepatocellular injury four days after the operation, but hyperbilirubinemia remained for several more days. The bile output and the concentration of the direct bilirubin in the bile drained from the autotransplanted hepatic segment were useful for monitoring its survival and function. Liver function is completely normal three months after the operation.

Key words
extracorporeal hepatectomy of the medial and anterior segments, autotransplantation of the posterior segment of the liver, in situ right trisegmentectomy of the liver

Reprint requests
Katsuhiro Tamura First Department of Surgery, Shimane Medical University
89-1 Enyacho, Izumo, 693 JAPAN

Accepted
January 8, 1992

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