Major liver resection for giant hepatic tumors in adults and children

With the evolution in surgical technique, anaesthetic care and postoperative management, major hepatic resections for giant liver tumors are now considered reasonably safe procedures with a low surgical death rate. The aim of this study is to evaluate the results of major hepatic resection for giant hepatic tumors in the National Liver Institute during the period between September 1991 and September 2001 and to compare these results with reports from other centers. From September 1991 to September 2001 twenty-six giant liver tumors undenvent major hepatic resection out of a total number of one hundred and thirty seven liver tumors that were resected in the National Liver Institute. The tumor diameter was ranging from 8 cm to 27 cm. There were 6 children: their ages ranged from 8 months to 13 years. Four of them had hepatoblastoma, one malignant mesenchymoma [undifferentiated embryonal sarcoma] and one case of liver cell adenoma. The adult group included 20 cases with a mean age of 52.5 years [range 26-65 years]. There were six cases of hepatocellular carcinoma [HCC]; two of them were done as an emergency due to bleeding after tumor rupture. The remaining 14 cases were: 2 cases of HCC fibrolammellar type, one gallbladder carcinoma, 2 cases of colorectal liver metastasis, 5 cases of haemangioma, one case of haemangioendothelioma, one case of secondary leomyosarcoma from the stomach, one case of cholngiocarcinoma and one case adenocarcinoma. Right or extended right hepatectomy was done in 14 patients and left or extended left hepatectomy was done in 12 cases. Ultrasonic dissector and bipolar coagulation was used in 21 cases. Hospital mortality was three cases; two of them were emergency cases on top of chronic liver disease. Postoperative complications included: temporary ascites, chest infection, minor biliary leak and wound infection. major liver resection is a reasonably safe procedure especially, when performed on normal liver under elective conditions

Duodeno-Gastric reflux before and after cholecystectomy

Duodenogastric reflux [DGR] has been suggested as an etiopathogenic factor in persisted of dyspeptic symptomes after cholycystectomy in some patients with gall stones disease. We evaluated the DGR in 10 gall stones diseased patients before and after simple. Cholecystectomy, in addition to 10 individuals with no oesophageal, gastric, duodenal, bilirary or pancreatic disease, but undewent any form of elective abdominal surgery other than gastric or biliary surgery taken as a control group. Their symptoms, gastric pH total and individual bile acids concentrations in fasting gastric juice and their refluxes were evaluated one day before and fifteen days after surgery. Gastric juice was obtained under fasting conditions by continuous nasogastric suction for a period of time extended from 10 hours in some subjects up to 24 hours in others. The total bile acids present in the samples were extracted by organic solvents and individual bile acids were fractionated and separated by thin-layer chromatography, then total and individual bile acids were quantified colorimetrically by the method described by Mashige et al., [1981]. Before Cholecystectomy, Right hypochondrium pain and biliary colic were present in 7 patients [70%] and dyspepsia in the form of heart burn, nausea, vomiting and flatulence with varying degrees in 8 patients [80%]. After surgery, biliary colic disappeared in all patients. Dyspeptic symptoms improved in 7 patients [70%], 3 patients [30%] remained with dyspeptic symptoms in the form of heart burn and flatutulence. The gastric pH was statistically highly significantly increased from 3.26 +/- 0.636 to 5.73 +/- 1.246 after Cholecystectomy, the total bile acids concentrations in fasting gastric juices were statistically highly significantly increased from 229.84 +/- 92.16 to 461.8 +/- 202.3 umol/l also the total bile acids refluxed per hours increased from 9.8 +/- 4.7 to 33.5 +/- 21.4 umol/h after, Cholecystectomy. Also, the studied individual bile acids and their refluxes per hours were statistically significantly increased after Cholecystectomy as follow; Glycocholic a. from 58 +/- 33.8 to 207.5 +/- 118.1 umol/l, Taurocholic a. from 95.5 +/- 55.9 to 100.5 +/- 47.4 umol/l Cholic a. from 10.9 +/- 15.06 to 38.5 +/- 37.6 umol/l, Lithocholic a. from 6.8 +/- 2.10 to 47.9 +/- 36.735 umol/l, also, their refluxes increased as follow; Glycocholic a. refluxed/h from 2.48 +/- 1.49 to 11.37 +/- 6.7 umol/h, Taurocholic a refluxed/h from 3.95 +/- 2.46 to 5.495 +/- 2.832 umol/h Cholic a. refluxed/h from 0.57 +/- 0.75 to 2.093 +/- 2.0921 umol/h and Lithocholic a. refluxed/h from 0.28 +/- 0.08 to 2.608 +/- 2.021 umol/h. The study showed no any statistically significant change in DGR between patients with or without dyspeptic symptoms after Cholecystectomy. Thus, inspite of occurrence and increase of DGR in all patients after Cholecystectomy we can not attribute the persistence of dyspeptic symptoms in some patients after surgery to DGR or to the changes of individual bile acids alone but may be to multiple factors as there is no any significant change in DGR between the patients with or without dyspeptic symptoms after surgery

Liver transplantation for primary hepatic leiomyosarcoma

The first case of successful liver transplantation for a primary hepatic leiomyosarcoma and a review of the pertinent literature was presented in this study. A 20-year old female presented with a moderately differentiated leiomyosarcoma 11.5 x 8 x 6 cm in diameter. The tumor originated from the caudate lobe with satellite metastases to both lobes in a non cirrhotic liver. There were no manifestations of extra-hepatic spread. It showed poor response to chemotherapy. Liver transplantation was performed with uneventful recovery. There is no evidence of disease recurrence at 19 months after surgery