Pancreatic and hepatic surgery
Last updated: November 22, 2019Summary
Pancreatic and hepatic surgeries are indicated in the management of malignant/symptomatic benign tumors and traumatic lacerations of the liver and pancreas. The choice of surgery depends on the location, size, and extent of the malignancy/injury. Depending on the extent of resection, pancreatic surgeries for malignancy include enucleation (for islet cell tumors), partial pancreatic resections (distal pancreatectomy, central pancreatectomy, pancreaticoduodenectomy/Whipple procedure), and total pancreatectomy. Chronic pancreatitis patients with a dilated main pancreatic duct (> 5 mm), not responding to conservative therapy, are candidates for lateral pancreaticojejunostomy with/without resection of the pancreatic head. Complications of pancreatic surgeries include anastomotic leaks, pancreatic ascites/fistula, and exocrine/endocrine insufficiency. Depending on which segments of the liver are removed, hepatic resections include right/left hepatectomy, right/left lobectomy, and segmentectomy. Wedge resections of the liver are performed for small, peripherally located lesions. Other complications of hepatic resections include liver failure, hemorrhage, hemobilia, and bile leaks.
Pancreatic surgery
Hepatic surgery
Anatomy of the liver
See the article on liver.
- Access: laparotomy (transverse, midline or subcostal incisions) or laparoscopy
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Pringle maneuver: temporary occlusion of the hepatic artery and portal vein by clamping of the free edge of the lesser omentum (hepatoduodenal ligament) in order to control vascular inflow to the liver or to reduce hemorrhage
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Cholecystectomy is routinely performed as part of all major hepatic resections to allow for easier dissection during the surgery.
- Cavitron ultrasonic surgical aspirator (CUSA): uses ultrasonic waves to vaporize only the liver cells while sparing the biliary radicles and blood vessels
Types of liver resections
| Type | Indications | Contraindications | Surgical procedure |
Anatomical resections | Right hepatectomy (right hemihepatectomy) |
|
|
- Segments V, VI, VII, and, VIII are removed.
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Right lobectomy (extended right hepatectomy or right trisegmentectomy) |
- Right hepatectomy and the additional removal of segments I and IV
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Left hepatectomy |
- Segments II, III, and IV are removed.
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Left lobectomy |
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Segmental resection | | |
- One or more anatomical segments are removed.
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Non-anatomical resection | Wedge resection |
- Peripherally located lesions
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- A triangular wedge of hepatic parenchyma containing the lesion is removed.
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Complications
Before performing extensive hepatic resections the future liver remnant (FLR) needs to be calculated (using CT images), as patients with insufficient FLR postresection, can develop liver failure!
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