Laparoscopic Liver Resection in Obese Patients

Toriguchi, Kan; Hatano, Etsuro; Sakurai, Takaki; Seo, Satoru; Taura, Kojiro; Üemoto, Shinji

doi:10.1007/s00268-014-2927-y

Cited by 25 publications

(24 citation statements)

References 51 publications

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“…However, LLR in obese patients is considered problematic. Despite this, several reports have stated that obesity should not be a contraindication for LLR [21, 22] and that LLR was less influenced by BMI and was beneficial in obese patients [23, 24]. In our case, despite the patient being severely obese (BMI 40 kg/m 2 ), LLR of the three separate lesions was successfully performed without excessive blood loss.…”

Section: Discussionmentioning

confidence: 62%

Case of resected multiple hepatocellular adenomas in a young man with severe obesity

et al. 2019

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Background Hepatocellular adenoma (HCA) is a rare liver tumor that has the potential for rupture and malignant transformation. Here, we report a case of multiple hepatocellular adenomas (HCAs) that were treated by surgical resection. Case presentation An 18-year-old man was admitted to our hospital with proteinuria. His height was 176.5 cm, weight was 126 kg, and body mass index was 40 kg/m 2 . A liver tumor was incidentally found on abdominal ultrasonography. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed three hepatic tumors that were 68 mm, 16 mm, and 9 mm in segments 3/4, 8, and 1, respectively. A percutaneous needle biopsy of the largest tumor was performed, the diagnosis of unclassified type HCA was made, and laparoscopic partial liver resection was performed of all three. The postoperative course was uneventful, and the patient was discharged 12 days later. An immunohistochemical examination revealed positivity for serum amyloid A protein, no decrease in fatty acid-binding protein, and negativity for β-catenin, glutamine synthetase, and cytokeratin 7. Therefore, these tumors were diagnosed as inflammatory type HCAs. Conclusions We reported an extremely rare case of multiple resected HCAs in a young, obese Japanese man. Our findings suggest that HCA should be considered in the differential diagnosis of liver tumor in obese patients. Further studies that consider clinical and molecular risk factors are required to establish individualized treatment plans for HCA in obese patients.

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Section: Discussionmentioning

confidence: 62%

Case of resected multiple hepatocellular adenomas in a young man with severe obesity

et al. 2019

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“…Laparoscopic liver surgery in this population presents a surgical challenge, and yet, since the BMI has not been reported to negatively affect the postoperative short-term outcomes in patients undergoing LLR, the laparoscopic approach is not considered to be a contraindication for obese patients (BMI, 32±2.0%) (8). A study by Toriguchi et al (9) underlined the benefits of LLR in obese patients, with a median BMI of 26.8% (range 25-38.2%), reporting significantly lower intraoperative blood loss and hospital stays compared with obese patients operated on with open liver resection (9). A more recent study exploring the impact of BMI on surgical outcomes in patients undergoing LLR (median BMI, 24.1±4.1%) compared with open LR (median BMI=23.1±3.9%) demonstrates that LLR in obese patients may be performed as safely as in non-obese patients, with the same risk of postoperative complications and with, additionally, lower operation times and levels of blood loss compared with non-obese patients (10).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic hepatectomy in a morbidly obese patient with liver cirrhosis: A case report

Machairas

Kostakis

Mantas

et al. 2016

Molecular and Clinical Oncology

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Cirrhotic patients constitute a high-risk population, and present a major challenge for the performance of minimally invasive laparoscopic resections due to difficulties in parenchymal transection. The present study describes the case of a 71-year-old morbidly obese male patient who was referred to our department with a hepatic mass identified on routine abdominal ultrasound. Abdominal computer tomography and magnetic resonance imaging confirmed a mass in segments V-VI of the liver, highly suspicious for HCC. The patient's past medical history additionally included non-alcoholic steatohepatitis, diabetes mellitus and arterial hypertension and myocardial infarction. The patient's body mass index was 45 kg/m, and the American Society of Anesthesiologists' classification of preoperative risk was 3. The patient underwent laparoscopic resection of segments V-VI and cholecystectomy. Two years postoperatively, the patient remains disease-free and in excellent condition. To the best of our knowledge, this is the first report on laparoscopic liver resection for such a morbidly obese patient in the context of advanced liver cirrhosis.

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“…In contrast to the few reports on SILL, there are numerous studies examining conventional MILL [ 33 ], [ 34 ], [ 35 ], [ 36 ], [ 37 ], [ 38 ], [ 39 ], [ 40 ], [ 41 ], [ 42 ], [ 43 ], [ 44 ], [ 45 ], [ 46 ], [ 47 ], [ 48 ], [ 49 ]. Among the reviewed SILL studies, intraoperative blood loss was 100 ml or less in 8 of 15 studies [ 18 ], [ 20 ], [ 21 ], [ 22 ], [ 28 ], [ 29 ], [ 31 ], [ 32 ] and LOS was shorter than 5 days in 8 studies as well [ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 24 ], [ 32 ], [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Single incision laparoscopic liver resection (SILL) – a systematic review

Benzing

Krenzien

Atanasov

et al. 2015

GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW; 4:Doc17

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Laparoscopic Liver Resection in Obese Patients

Abstract: LLR in obese patients results in decreased intraoperative blood loss and shorter postoperative hospital stays compared with OLR. When performed in selected patients, LLR may be a safe and feasible option for obese patients.

Cited by 25 publications

References 51 publications

Case of resected multiple hepatocellular adenomas in a young man with severe obesity

Case of resected multiple hepatocellular adenomas in a young man with severe obesity

Laparoscopic hepatectomy in a morbidly obese patient with liver cirrhosis: A case report

Single incision laparoscopic liver resection (SILL) – a systematic review

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