Management of Giant Hepatic Hemangiomas-Our Experience
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 1
Abstract
. Giant hemangiomas (GH) are those which are more than 4 cm and are frequently symptomatic and may be associated with complications due to local compression or rupture or rare coagulopathy syndrome like Kasabach-Merritt Syndrome(KMS) which are indications for surgery. Surgery can be either enucleation or hepatic resection where enucleation is the preferred surgery of choice and hepatic resection reserved for rare indications like complete lobe involvement . Enucleation the procedure of choice and is safer, quicker and associated with less morbidity than liver resection with certain exceptions like total replacement of a lobe. METHODOLOGY All cases of operated giant hepatic hemangiomas were retrospectively analysed and statistical analyss done using unpaired t test for test of significance . p<.05 was statistically significant. From 2007-2017, 17 cases of giant hemangiomas(M:F::1:16) were operated. The mean age of the patients was 41.6 years(22-60 years). The main symptoms incuded abdominal pain (N=16,94.1%), and abdominal mass(N=14, 82.3%) . Surgical removal of hepatic hemangiomas was performed due to intractable symptoms (12 cases), size increase (1 case), and liver failure (1 case)and uncertain diagnosis (3 cases) In all, 3 patients underwent enucleation of hemangiomas, while the remaining 14 underwent anatomical resection. The surgeries included righthepatectomy in 7 , left hepatectomy in 3 and left lateral segmentectomy in 4 cases. One patient underwent preoperative angioembolisation as the tumour was very large(5.2 kg on post op measurement) and then followed by sorafenib. Unfortunately, patent did not tolerate sorafenib treatment. and hence had to be taken for surgery expeditiously.One patient had features of KMS (KasselbachMerrit Syndrome) and had to be managed for the same . The Pringle maneuver was done in 2 cases Parenchymal transection was done using a combination of kellyclysis and diathermy in most cases.The mean blood loss and operative time for patients undergoing enucleation was 500 ml(range, 500-600 ml) and 146 min(range ,140-150 min) which was statistically less than that for patients undergoing anatomical resection at 746 ml(300-200ml) and 193.5 min(140-420 min ) . (p<.05).The mean hospital stay was also less for those undergoing enucleation (12.7 days, range-7-18 days) than anatomical resection.(10.3days,range 10-11 days)(p<0.05) We observed one perioperative mortality inpatient with liver steatosis who had post operative liver failure . and two cases of major morbidity (bile leaks not requiring reoperation). All patients (were completely cured of their symptoms and remain alive and in good health, without longterm complications, after a follow-up period ranging from 1 month to 10 years
Authors and Affiliations
Amarjothi J M V, NaganathBabu O L, Villalan R, Jeyasudhahar J
Keywords
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- EP ID EP434783
- DOI 10.9790/0853-1801082326.
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