Giant hemangiomas of the liver: surgical strategies and technical aspects

Abstract

The incidence of hemangiomas is 2-7% in the general population. We evaluated more than 300 patients with hepatic hemangiomas. Surgical removal of hepatic hemangiomas was performed in 48 cases due to uncertain diagnosis (2 cases), intractable symptoms (26 cases), size increase (18 cases), and liver failure in 2 cases that were treated by hepatic transplantation. In all, 26 patients underwent enucleation of hemangiomas or segmentectomies, while the remaining 20 patients underwent right lobectomies or left lateral segmentectomies. Blood transfusions were required in four cases (including two liver transplants); mean post-resection hospital stay was 6.3 days. We observed no perioperative mortality and only two cases of major morbidity (bile leaks not requiring reoperation). Our experience confirms that, after adequate patient selection, surgical treatment of hepatic hemangiomas is a very effective therapeutic choice with no mortality and low morbidity.

Removal of a giant hepatic hemangioma by enucleation after selective hepatic artery embolization

“…Çoğunlukla soliter olmasına karşın olguların %40'ında bilateral ve multipl olarak bulunmaktadır (7,8). Nadiren 5 cm'den daha büyük olur ve bu durumda dev KH olarak adlandırılır (9). KH'ları genellikle asemptomatiktirler, başka bir rahatsızlık nedeniyle tetkik edilen olgularda tesadüfi olarak fark edilmeleri nadir değildir (10,11).…”

“…Ağrı şikayetleri olan ya da çevre organlara olan basıya ait semptomları olan olgularda cerrahi tedavi düşünülmelidir. Yakınmalar çoğunlukla büyüyen kitlenin Glisson kapsülünde gerginlik ya da inflamasyon yapmasına bağlı abdominal ağrı şeklindedir (6,9,12). Kitle büyüyerek çevre organları itmesiyle de bası semptomlarına neden olabilir.…”

Atypical Hepatic Hemangioma

“…5 Absolute indications for surgery include rupture, rapid changes in size, and hemangioma-induced Budd-Chiari or Kasabach-Merritt syndromes; other indications include uncertain diagnosis, severe intractable symptoms, and liver failure. 6 Surgical mortality following the resection of benign hepatic tumors has been reported to range from 0% to 5% and is largely related to the location of the lesion rather than the extent of surgical resection. 5 Resection of tumors near the caudate lobe has been associated with mortality rates as high as 10%, with statistics for the right and left lobes significantly lower.…”