Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients.

ABSTRACT

BACKGROUND/AIMS: For treatment of centrally located hepatocellular carcinoma (HCC), mesohepatectomy is a technically demanding procedure. The technique of an intrahepatic access to Glissonian pedicles achieves a safe inflow blood control of the liver segments to be resected and allows the anatomical removal of the tumor-bearing segment(s). No reports have mentioned the use of an intrahepatic access for mesohepatectomy in cirrhotic livers. METHODOLOGY: Seventeen consecutive patients underwent mesohepatectomy between January 1, 2005, and September 30, 2007. All these patients had hepatocellular carcinoma. The surgery was performed by making 3 small incisions around the hilar-plate, the gallbladder bed, and the round ligament. With a standardized method, the right anterior and left medial sheaths were reached by combining these incisions. RESULTS: Mesohepatectomy was feasible with the proposed technique in all patients. No patients experienced massive bleeding during the operation, and 14 patients did not require blood transfusion. Minor postoperative complications were observed in 8 patients and resolved with conservative management. No hospital mortality occurred. CONCLUSIONS: Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients is safe and effective. It may reduce intraoperative blood loss and the need for the Pringle maneuver.