ABSTRACT
BACKGROUND: Massive hepatic necrosis from hepatic artery (HA) interruption is a complication after extended pancreatobiliary operation. The effectiveness of a mesenteric arterioportal shunt in preventing liver failure after massive hepatic necrosis was evaluated. METHODS: Of 98 patients who underwent pancreatic or hepatic resection for pancreatobiliary carcinoma between January 1989 and December 1995, six received a mesenteric arterioportal shunt. Clinical and hemodynamic analyses were done retrospectively. RESULTS: The six patients were classified into groups: A, postoperative hepatic arterial occlusion and, B, main HA excision without reconstruction. One patient in group A and three patients in group B had good arterioportal shunt patency and favorable clinical courses. However, fatal hepatic necrosis after ligation of the HA proper occurred in one patient in group A from small portal flow despite a presumed patent shunt. In another patient in group A angiogram revealed shunt occlusion. CONCLUSIONS: A mesenteric arterioportal shunt is beneficial when massive hepatic necrosis has occurred or is expected after main HA interruption under such conditions as postoperative hepatic arterial occlusion or HA excision without reconstruction. The procedure has the advantages of appropriate selection of artery size, a lower abdominal site apart from the primary operative field, and easy shunt closure by transarterial embolization.
Subject(s)
Arteriovenous Shunt, Surgical , Gallbladder Neoplasms/surgery , Hepatic Artery/surgery , Liver Neoplasms/surgery , Mesenteric Arteries/surgery , Pancreatic Neoplasms/surgery , Portal Vein/surgery , Aged , Female , Follow-Up Studies , Humans , Liver/pathology , Male , Middle Aged , Necrosis , Postoperative Complications/prevention & controlABSTRACT
Postoperative hepatic failure was treated by plasma adsorption (PA) to charcoal and ion-exchange resin in five patients suffering from pancreatic or biliary carcinoma that was not accompanied by liver cirrhosis. Four of these patients recovered completely from the hepatic failure, while the fifth patient recovered sufficiently to be taken off the treatment for three weeks. Reactions in platelet counts and circulatory system during and after the PA treatment were minimal in all these patients. PA proved to be an effective liver support system for treating non-cirrhotic patients with postoperative hepatic failure.
