Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 961-968
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.961
Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy
Masashi Isetani, Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa
Masashi Isetani, Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Aichi, Nagoya 454-8509, Japan
Author contributions: Isetani M and Morise Z wrote the manuscript; Kawabe N, Tomishige H, Nagata H, Kawase J, and Arakawa S collected the data and assisted in writing the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zenichi Morise, MD, PhD, FACS, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, 3-6-10 Otobashi Nakagawa-ku, Aichi, Nagoya 454-8509, Japan. zmorise@fujita-hu.ac.jp
Telephone: +81-52-3235680 Fax: +81-52-3234502
Received: April 16, 2014
Peer-review started: April 17, 2014
First decision: July 21, 2014
Revised: August 10, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 21, 2015
Abstract

AIM: To assess clinical outcomes of laparoscopic hepatectomy (LH) in patients with a history of upper abdominal surgery and repeat hepatectomy.

METHODS: This study compared the perioperative courses of patients receiving LH at our institution that had or had not previously undergone upper abdominal surgery. Of the 80 patients who underwent LH, 22 had prior abdominal surgeries, including hepatectomy (n = 12), pancreatectomy (n = 3), cholecystectomy and common bile duct excision (n = 1), splenectomy (n = 1), total gastrectomy (n = 1), colectomy with the involvement of transverse colon (n = 3), and extended hysterectomy with extensive lymph-node dissection up to the upper abdomen (n = 1). Clinical indicators including operating time, blood loss, hospital stay, and morbidity were compared among the groups.

RESULTS: Eighteen of the 22 patients who had undergone previous surgery had severe adhesions in the area around the liver. However, there were no conversions to laparotomy in this group. In the 58 patients without a history of upper abdominal surgery, the median operative time was 301 min and blood loss was 150 mL. In patients with upper abdominal surgical history or repeat hepatectomy, the operative times were 351 and 301 min, and blood loss was 100 and 50 mL, respectively. The median postoperative stay was 17, 13 and 12 d for patients with no history of upper abdominal surgery, patients with a history, and patients with repeat hepatectomy, respectively. There were five cases with complications in the group with no surgical history, compared to only one case in the group with a prior history. There were no statistically significant differences in the perioperative results between the groups with and without upper abdominal surgical history, or with repeat hepatectomy.

CONCLUSION: LH is feasible and safe in patients with a history of upper abdominal surgery or repeat hepatectomy.

Keywords: Chronic liver disease, Laparoscopic hepatectomy, Liver tumor, Repeat hepatectomy, Surgical history

Core tip: The clinical outcomes of laparoscopic hepatectomy (LH) in patients with a history of upper abdominal surgery and repeat hepatectomy were evaluated. Of 80 patients who underwent pure LH, 22 had prior upper abdominal surgeries, and 12 underwent repeat hepatectomy. There were no conversions to laparotomy. There were no significant differences in operative time, blood loss, morbidity, or postoperative hospital stay between patients with and without prior abdominal surgery. LH with upper abdominal surgical history and repeat hepatectomy is feasible and safe for select patients.