Surgery of benign liver tumors: indications for treatment: twenty years' experience.

BACKGROUND/AIMS: The aim of this study is to give an audit of the experiences in the Institute of Experimental Surgery, at the University of Szeged, over the past 2 decades in the form of a retrospective study. METHODOLOGY: Between January 1982 and December 2001, 132 patients with benign liver tumor (adenoma: 22; focal nodular hyperplasia: 27; hemangioma: 83) were treated. A total of 112 patients underwent surgery, while 20 asymptomatic cases were merely observed. The mean age, the female/male ratio and the size of the tumor in the adenoma cases were 38.2 years, 20/2 and 7.7cm, while for focal nodular hyperplasia they were 39.4, 24/3 and 6.3cm, and for hemangioma 49.0, 62/21 and 6.5cm. The results were compared and analyzed statistically. RESULTS: Enucleation was performed in 45.4% of the patients, nonanatomical resection in 35.6%, segmentectomy in 7%, lobectomy in 3.8%, extended lobectomy in 1.5%, stitching in 4.5%, exploration in 2.3% and liver transplantation in 0.8%. The mortality was 0.8%. Complications occurred in a total of 23.5% of the cases. CONCLUSIONS: Patients with asymptomatic focal nodular hyperplasia or hemangiomas must be excluded from surgery. Surgery is indicated only when growth or severe complaints are observed. Adenomas must be resected because of the precancerous behavior and the danger of bleeding from a rupture.

Liver abscess caused by Stenotrophomonas maltophilia: report of a case.

We report the case of a melioidosis-like abscess of the liver caused by Stenotrophomonas (Xanthomonas) maltophilia infection in a Chinese man living in Hungary. Although this appears to be the first documentation of a liver abscess of this origin in a nonimmunocompromised patient, our case report demonstrates that this common facultative pathogen can also cause liver abscess and sepsis. After repeated negative blood cultures, histological examinations of liver biopsies suggested the possibility of chronic melioidosis, but the microbiological examination performed directly on the same specimen identified a Stenotrophomonas maltophilia infection. Surgical drainage was performed and sulphamethoxazole/trimethoprim therapy was commenced, after which the patient recovered fully. The facultative pathogen S. maltophilia, which most often causes nosocomial infections, may cause severe sepsis and liver abscess. We wish to draw attention to the fact that the antibiotic sensitivity of S. maltophilia is not necessarily the same in vivo and in vitro. This can create difficulties in both diagnosis and treatment.

Experience with different methods of treatment of nonparasitic liver cysts.

BACKGROUND AND AIMS: In a search for the optimal management of nonparasitic liver cysts, a study was made of the effectiveness of different methods. PATIENTS AND METHODS: Between 1 January 1982 and 15 December 2001 we treated 132 patients with nonparasitic liver cysts. In 72 patients 31 cysts were treated with enucleation, 60 with deroofing, and 24 with stitching by laparotomy; two liver resections were also performed. In a further 34 patients 36 cysts were treated with deroofing by minimally invasive surgery. In an additional 26 patients 32 cysts were treated with various interventional radiological methods. RESULTS: There was no mortality. The morbidity rate after laparotomy was significant (22.2%). The rate of recurrence after enucleation and deroofing was 6.5% and 13.8%, respectively, but there were no recurrences after stitching and liver resection. The recurrence rate following laparoscopic deroofing was 19.4%, and that following interventional radiological procedures was 50%. CONCLUSIONS: Treatment is required only if cysts are highly symptomatic or if growth is detected. Interventional radiological methods do not prove more favorable than surgery. Laparoscopic fenestration is preferred because of its low morbidity and the short period of hospitalization. Traditional surgical methods should be reserved merely for cases in which laparoscopic deroofing is not feasible.