Planejamento pré-operatório em hepatectomias

Abstract

Hepatectomy can comprise excision of peripheral tumors as well as major surgeries like trisegmentectomies or central resections. Patients can be healthy, have localized liver disease or possess a cirrhotic liver with high operative risk. The preoperative evaluation of the risk of postoperative liver failure is critical in determining the appropriate surgical procedure. The nature of liver disease, its severity and the operation to be performed should be considered for correct preparation. Liver resection should be evaluated in relation to residual parenchyma, especially in cirrhotic patients, subjects with portal hypertension and when large resections are needed. The surgeon should assess the rationale for the use of hepatic volumetry. Child-Pugh, MELD and retention of indocyanine green are measures for assessing liver function that can be used prior to hepatectomy. Extreme care should be taken regarding the possibility of infectious complications with high morbidity and mortality in the postoperative period. Several centers are developing liver surgery in the world, reducing the number of complications. The development of surgical technique, anesthesia, infectious diseases, oncology, intensive care, possible resection in patients deemed inoperable in the past, will deliver improved results in the future.

Liver Resections for Metastasis: Surgical Outcomes of a Single Center Academic Institution

“…Our study presented an overall rate of postoperative complications of 11.6%, even including a large percentage of major LRs (79.6%) -higher than the percentages found in other Brazilian series, with 31.4% and 43.2% (15,16). Considering that the complication rates have progressive increase according to the extent of LR, these values are in line with those found in literature (8).…”

A protocol of hepatic volume measurement using magnetic resonance imaging in individuals from the Eastern Brazilian Amazon population

“…The use of hepatic volume is a reliable and safe form when major resections are mandatory. The rational way to calculate the hepatic volume is to have the hepatic volume measured by the surgeon himself [13,14].…”

Comparison between electrocautery and fibrin selant after hepatectomy in rats

“…the complications inherent to hepatectomy, postoperative bleeding has been a decisive factor of morbidity. It occurs due to the characteristics of the liver tissue, such as friability, Intense vascularization, absence of smooth muscle to can cause vasoconstriction, making it difficult to control bleeding 3 . This motivated this research, in an attempt to determine methods to promote hemostasis after trauma and liver resections.…”

“…The development of specific anesthesia routines, evolution of pre-and postoperative care, ventilatory and hemodynamic support and also conducting of operations in specialized centers are directly related to the decreased the rates of morbidity and mortality 1,2 . The risks include liver failure, infection, biliary fistula and massive bleeding 3 , the latter being the most dreaded by surgeons.…”