Right trisectionectomy of the liver for intrahepatic cholangiocarcinoma with bile duct invasion in a Jehovah's Witness

Abstract

Intrahepatic cholangiocarcinoma (ICC) is well known to have a very poor prognosis. Aggressive surgical strategies in the treatment of ICC, including major hepatectomy, have been reported to afford patients the best chance for significant survival. Recent advancements in surgical techniques concerning live donor liver transplantation have dramatically improved the results of major hepatectomy. However, surgical treatment of biliary malignancy is complex and is known to increase the likelihood of blood transfusion. We describe a Jehovah's Witness patient with ICC and concomitant bile duct invasion who had a successful right trisectionectomy with bile duct resection, lymph node dissection, and Rouxen-Y hepatico-jejunostomy without blood transfusion. A multidisciplinary preparation was crucial in obtaining this positive outcome. Importantly, bloodless liver transection techniques with inflow clamping, meticulous dissection, and hemostasis should be utilized for major hepatectomy in a Jehovah's Witness. The success of this case may alert clinicians to consider a hepatectomy as a possible option in the treatment of ICC in a Jehovah's Witness.

Central hepatectomy for hepatocellular carcinoma in a patient with anti-Gerbich antibody

“…3 Peri-and intra-operative course of Hb and Ht values with description of PAD and ANH under erythropoietin therapy. Hb: hemoglobin; Ht: hematocrit; PAD: preoperative autologous donation; ANH: acute normovolemic hemodilution; Pre: preoperative day; DOS: day of surgery; Nadir: intraoperative hemoglobin nadir; Recovery: in recovery room erythropoietin supplemented by daily administration of iron [9,10]. The patient underwent 2 times of PAD as often as once a week with 400 ml withdrawal of whole blood until 72 h before surgery [11].…”

Ruptured Intrahepatic Biliary Intraductal Papillary Mucinous Neoplasm in a Jehovah's Witness Patient

“…9 This required a careful perioperative strategy and a meticulous surgical technique that would minimize the intra-operative blood loss. 2 Preoperative management of these patients may include the use of recombinant human erythropoietin and intravenous iron therapy. 10,11 Intraoperatively, this patient could accept intravenous dextran.…”

“…However, a major hepatic surgery can be performed without blood transfusion sometimes, including such cases dealing with Jehovah's Witness patients. 2,3 To the best of our knowledge, this is the first report of a successful treatment for ruptured biliary IPMN without blood transfusion in a Jehovah's Witness patient worldwide.…”

Successful transfusion-free pancreatectomy in Jehovah's Witness patients

“… 1 2 3 4 There has been a persistent lack of blood products, and the lack of alternatives products has promoted TF surgeries even in hepatobiliary surgery including liver transplantation. 5 6 7 8 9 …”