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

Alikhanov R.B.

Loginov Moscow clinical research center of the Moscow Department of health

Efanov M.G.

Loginov Moscow clinical research center of the Moscow Department of health

Subbotin V.V.

Loginov Moscow clinical research center of the Moscow Department of health

ORCID: 0000-0002-0921-7199

Novikova E.V.

Loginov Moscow clinical research center of the Moscow Department of health

Shchadrina K.V.

Loginov Moscow clinical research center of the Moscow Department of health

Buldakov M.Y.

Loginov Moscow clinical research center of the Moscow Department of health

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

Authors:

Alikhanov R.B., Efanov M.G., Subbotin V.V., Novikova E.V., Shchadrina K.V., Buldakov M.Y.

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Journal: Pirogov Russian Journal of Surgery. 2020;(12): 88‑92

DOI: 10.17116/hirurgia202012188

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To cite this article:

Alikhanov RB, Efanov MG, Subbotin VV, Novikova EV, Shchadrina KV, Buldakov MY. Treatment of severe post-resection liver failure. Analysis of the specialized center. Pirogov Russian Journal of Surgery. 2020;(12):88‑92. (In Russ.)
https://doi.org/10.17116/hirurgia202012188

Подписка 2025 (Pirogov Russian Journal of Surgery)

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Posthepatectomy liver failure is one of the most serious complications of large liver resections.

OBJECTIVE

The analyzes the management and results of treatment of patients with severe posthepatectomy liver failure (Grade C ISGLS) in a specialized hepatosurgical department.

MATERIAL AND METHODS

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.

RESULTS

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%).

CONCLUSIONS

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.

Keywords:

liver resection

hepatic resection

hepatic failure

posthepatectomy liver failure

Authors:

Alikhanov R.B.

Loginov Moscow clinical research center of the Moscow Department of health

Efanov M.G.

Loginov Moscow clinical research center of the Moscow Department of health

Subbotin V.V.

Loginov Moscow clinical research center of the Moscow Department of health

ORCID: 0000-0002-0921-7199

Novikova E.V.

Loginov Moscow clinical research center of the Moscow Department of health

Shchadrina K.V.

Loginov Moscow clinical research center of the Moscow Department of health

Buldakov M.Y.

Loginov Moscow clinical research center of the Moscow Department of health

Received:

10.10.2020

Accepted:

02.11.2020

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