Treatment of severe post-resection liver failure. Analysis of the specialized center

Posthepatectomy liver failure is one of the most serious complications of large liver resections. The analyzes the management and results of treatment of patients with severe posthepatectomy liver failure (Grade C ISGLS) in a specialized hepatosurgical department. In the period from January to Decem...

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Bibliographic Details
Published in:	Hirurgija (Moskva) no. 12; p. 88
Main Authors:	Alikhanov, R B, Efanov, M G, Subbotin, V V, Novikova, E V, Shchadrina, K V, Buldakov, M Y
Format:	Journal Article
Language:	Russian
Published:	Russia (Federation) 2020
Subjects:	Hepatectomy - adverse effects Hepatectomy - methods Hospitals, Special Humans Liver Diseases - surgery Liver Failure - diagnosis Liver Failure - etiology Liver Failure - therapy Liver Neoplasms - surgery Retrospective Studies liver resection hepatic resection posthepatectomy liver failure hepatic failure
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Summary:	Posthepatectomy liver failure is one of the most serious complications of large liver resections. The analyzes the management and results of treatment of patients with severe posthepatectomy liver failure (Grade C ISGLS) in a specialized hepatosurgical department. In the period from January to December 2019, 175 liver resections were performed in the Department of liver and pancreatic surgery at the A.S. Loginov Moscow Clinical Scientific Center. Major-volume liver resections (hemihepatectomies and resections of more than three liver segments) were performed in 80 (45%) patients. In 125 (71%) cases liver resctions were performed for malignant liver and bile duct diseases. Laparoscopic liver resections were performed in 77 (44%) patients. Postresection liver failure developed in 18 (10.2%) patients. Severe (class C according to ISGLS) developed in 6 (3.4%) patients. In the postoperative period (90-day mortality), 4 patients (2.3%) died, while in two patients, mortality was not associated with liver failure. Hyperbilirubinemia was observed for more than 5 days in 2 (33.3%), coagulopathy in 4 (66.6%), ascites in 5 (83.3%), encephalopathy in 5 (83.3%), hypoglycemia in 3 (50%), and uncontrolled sepsis in 2 (33.3%) patients, respectively. Correction of surgical complications was required in 100% of cases, which consisted in drainage of abscesses and abdominal bylomas, and the the bilio-digestive anastomosis fistulas. Inotropic support was required in all 6 (100%) patients, invasive ventilation in 4(66.6%), and extracorporeal detoxification in 5 (83.3%). Posthepatectomy liver failure is a complex problem even in a specialized center. A comprehensive approach to treatment allows to achieve noticeable results and reduce mortality.
ISSN:	0023-1207
DOI:	10.17116/hirurgia202012188