Background: We compared retrospectively the results of
the patients who underwent hemihepatectomy through
anterior approach (AHH) with those undergoing conventional
hemihepatectomy (HH). Patients and Methods: In
119 patients hemihepatectomy was done, 52 of them
were anterior approaches. We used this technique if the
tumor size was large or if the tumor seemed to be fragile,
and thus a liver mobilization would be very dangerous.
We started the operation with dissecting parenchyma
from the anterior surface toward hilus without preparation
of the hilus. Resection of the liver was performed
with the help of CUSA dissector. Results: No patient died
following AHH. Two re-operations were performed in the
HH group, and 2 patients died. The operation time was
not significantly different in both groups. The need for
blood transfusion was much less during AHH. The average
nursing days were also similar in both groups. However,
in those cases in which the operations were performed
because of liver malignancies, there were no differences
in the survival rate after 32-month follow-up between
both groups. Conclusions: AHH can be performed
safely. The blood consumption during AHH is significantly
lower than during HH. The median survival rate was
similar in both groups. Our team suggest the anterior
approach for liver resection in those cases when the
hilar structures and the hepatic veins cannot be isolated
easily.
A paraesophageal hernia was diagnosed in a 67-year-old female patient suffering from epigastric pain and gastroesophageal reflux disease. The patient underwent laparoscopy. Beside the paraesophageal hernia, a Morgagni hernia was also observed, with a significant part of the omentum herniated in the sac. A 360-degree Nissen fundoplication was performed, the Morgagni hernia sac was not resected, and its closure was performed with interrupted sutures. No complications were observed in the postoperative period and on one-year follow-up the patient was free of symptoms.
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