[Is extracorporeal liver surgery useful for difficult hepatic resections?]. / La chirurgie ex situ du foie est-elle utile au cours des résections hépatiques difficiles?

Five cases of hepatic tumor deemed unresectable by conventional techniques are presented to illustrate the potential benefit offered by complete hepatic vascular exclusion (Pringle maneuver associated with inferior vena cava clamping below and above the liver). The most extensive and difficult liver resections may be achieved, with possible venous reconstruction, if the clamping period is not interrupted. Hepatic vascular exclusion may exceed one hour, up to 85 minutes in this series, with a good liver tolerance, in the absence of preoperative liver dysfunction. The advantages and disadvantages of the ex situ extracorporeal liver resections performed under similar circumstances are discussed. The authors consider that the role of ex situ liver procedures should be very limited.

[Is ex situ surgery of the liver useful for difficult hepatic resections?]. / La chirurgie ex situ du foie est-elle utile au cours des résections hépatiques difficiles?

Five cases of hepatic tumor deemed unresectable by conventional techniques are presented to illustrate the potential benefit offered by complete hepatic vascular exclusion (Pringle maneuver associated with inferior vena cava clamping below and above the liver). The most extensive and difficult liver resections may be achieved, with possible venous reconstruction, if the clamping period is not interrupted. Hepatic vascular exclusion may exceed one hour, up to 85 minutes in this series, with a good liver tolerance, in the absence of preoperative liver dysfunction. The advantages and disadvantages of the ex situ extracorporeal liver resections performed under similar circumstances are discussed. The authors consider that the role of ex situ liver procedures should be very limited.

[Is ischemia of the liver, lasting longer than an hour, a severity factor in hepatectomies? Apropos of 19 cases]. / L'ischémie du foie de plus d'une heure est-elle un facteur de gravité des hépatectomies? A propos de 19 cas.

Nineteen hepatic resections with continuous liver ischemia exceeding one hour (60 to 85 min, m = 68 +/- 8 min) are reported. Surgery was undertaken for 15 malignant tumors, mainly metastatic, and 4 benign tumors. In 16 out of 19 cases, a major hepatic resection was necessary to remove massive and central lesions. Vascular clamping was a Pringle maneuver (9 cases), associated with inferior vena cava clamping-complete hepatic vascular exclusion (10 cases). 2050 +/- 2000 ml of packed red cells were infused peroperatively. No operative nor hospital mortality was recorded. Major complications developed in 6 patients: 3 intraperitoneal haemorrhages leading to complementary hemostasis of the raw surface of the liver in the first 24 hours, 1 erosive gastritis, 2 subphrenic abscesses treated by percutaneous drainage. Severe liver failure developed after left trisegmentectomy on a steatotic liver and led to emergency transplantation on the 17th day with success. Except this case, biochemical liver tests demonstrated slight and transitory alteration. Magnetic resonance imaging confirmed the rapidity of the regenerative process and liver biopsies at 6 and 12 months did not show any late changes. There is no relation between the duration of liver ischemia in the limits of this study and post operative morbidity rate, which is more influenced by the magnitude of the resection and the quality of the liver remnant.

[Technic of continuous axillary plexus block]. / Technique du bloc plexique prolongé par voie axillaire.

A technique of continuous axillary brachial plexus block, using an epidural Tuohy needle and an epidural catheter, is described. Studies were carried out in ten patients using this technique with bupivacaine as a local anesthetic drug. The catheter remained indwelling during a mean period of five days. Good analgesia was obtained in nine out of the ten patients. Thus this technique allows pain-free postoperative period in hand surgery.