Brief Article
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World J Gastrointest Surg. Jul 27, 2011; 3(7): 101-105
Published online Jul 27, 2011. doi: 10.4240/wjgs.v3.i7.101
Laparoscopic liver resection for hepatocellular adenoma
Mohammed Abu Hilal, Francesco Di Fabio, Robert David Wiltshire, Mohammed Hamdan, David M Layfield, Neil William Pearce
Mohammed Abu Hilal, Francesco Di Fabio, Robert David Wiltshire, Mohammed Hamdan, David M Layfield, Neil William Pearce, Hepatobiliary and Pancreatic Surgical Unit, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
Author contributions: Abu Hilal M and Di Fabio F contributed equally to this work; Abu Hilal M, Di Fabio F, Wiltshire RD, Hamdan M, Layfield DM and Pearce NW designed the research; Abu Hilal M, Di Fabio F, Wiltshire RD, Hamdan M and Pearce NW performed the research; Abu Hilal M and Di Fabio F analyzed the data; Abu Hilal M and Di Fabio F wrote the paper.
Correspondence to: Mohammed Abu Hilal, MD, PhD, FRCS, Consultant Hepatobiliary and Pancreatic Surgery, Honorary Senior lecturer, Southampton School of Medicine, Southampton University Hospitals NHS Trust, F level, Tremona Road, Southampton, SO16 6YD, United Kingdom. abu_hlal@yahoo.com
Telephone: +44-2380-796796 Fax: +44-2380-796620
Received: December 7, 2010
Revised: July 12, 2011
Accepted: July 18, 2011
Published online: July 27, 2011
Abstract

AIM: To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma (HA).

METHODS: We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA.

RESULTS: Thirteen patients underwent fifteen pure laparoscopic liver resections for HA (male/female: 3/10; median age 42 years, range 22-72 years). Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas. Indications for surgery were: symptoms in 12 cases, need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case. Symptoms were related to bleeding in 10 cases, sepsis due to liver abscess following embolization of HA in one case and mass effect in one case (shoulder tip pain). Five cases with ruptured bleeding adenoma required emergency admission and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed. Eight patients (62%) required major hepatectomy [right hepatectomy (n = 5), left hepatectomy (n = 3)]. No conversion to open surgery occurred. The median operative time for pure laparoscopic procedures was 270 min (range 135-360 min). The median size of the excised lesions was 85 mm (range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization. Mortality was nil. The median hospital stay was 4 d (range 1-18 d) with a median high dependency unit stay of 1 d (range 0-7 d).

CONCLUSION: The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.

Keywords: Laparoscopy; Minimally-invasive surgery; Hepatocellular adenoma; Major hepatectomy; Outcome