Postoperative problems and management after hepatic resection for blunt injury to the liver

Abstract

The postoperative problems and management of 8 patients following right hepatic lobectomy for blunt liver injury are discussed. Multiple injury and in particular chest injury are of importance. Respiratory distress may be insidious in onset and must be anticipated. Most patients require at least temporary positive pressure ventilation. Liver regeneration is rapid and histological evidence of regenerative hyperplasia is present within 3 days of injury. Hypoglycaemia of a degree sufficient to threaten life may occur postoperatively, particularly in the first 48 hours. Jaundice may be a worrying postoperative feature, but the use of T-tube drainage after hepatic lobectomy will enable any possible extrahepatic obstruction to be excluded. Hypoproteinaemia and hypo-albuminaemia occur in the immediate postoperative period, and recovery rapidly follows the peak period of regenerative activity of the liver. Normal levels are regained by the fourth to sixth postoperative weeks. Prophylactic antibiotics have no place in the postoperative management of blunt liver injury. Haemorrhagic diathesis is common after hepatic resection and is of a complex nature. Intravascular coagulation may occur and factor V deficiency is common. The mainstay of treatment is transfusion of fresh blood.

The effects of prolonged hepatic ischaemia before 70 per cent partial hepatectomy in the dog

“…PARTIAL hepatectomy in man is known to result in disordered liver function, indicated by abnormal biochemical tests and impaired synthesis of coagulation factors (Vajrabukka et al, 1975). In patients who undergo partial hepatectomy for major hepatic trauma, prolonged hypotension probably contributes to diminished liver function, and observations which we have made in the dog confirmed that the impairment of hepatic function is increased when partial hepatectomy is preceded by periods of total ischaemia of the liver remnant of up to 1 hour (Mackenzie et al, 1975).…”

The influence of liver and pancreas surgery on the thyroid function

“…It is tempting to speculate that novel finding could be explained by an increased proportion of free thyroid hormones after liver surgery, caused by lower thyroid hormone binding proteins concentrations (hypoproteinemia) [15,16]. Another explanation might be based on an assumption that pancreatic surgery – generally - is a more serious procedure with more serious complications and lower free thyroid hormones levels are known to be a manifestation of particularly deep and serious metabolic disturbances.…”

Bile Peritonitis following Major Hepatic Resection – Clinical and Experimental Studies

“…However, the role played by bile chemical peritonitis on hepatic energy metabolism and regeneration is not well understood. It is thought that sterile intraperitoneal accu mulations of bile may affect liver regeneration because early regeneration, as measured by DNA synthesis, has been reported to be completed within 1 week following hepatic resection [21],…”