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General Surgery
Perspective on Liver Surgery (A)
Built from Maingot's Abdominal Operations
What’s inside
6 sections · 82 slides
Overview
- Scope of this account
- Terms used throughout
Expansion of liver surgery
Why more surgeons now operate on the liver, and why it is safer
- Expansion of liver-directed surgery
- Drivers of safer liver surgery
- Segmental anatomy of the liver
- Junctional division and the eight liver segments
- Variation in hepatic vascular and biliary anatomy
- Dual blood supply of the liver
- Inflow occlusion during liver operations
- Effect of inflow occlusion on blood loss
- Intermittent occlusion and reperfusion
- Techniques for hepatic parenchymal transection
- Equipment in the hepatobiliary operating room
- Choice of transection technique
Hepatic abscess and cystic disease
Pus, parasites and fluid-filled lesions in the liver
- Pyogenic liver abscess
- Iatrogenic causes of pyogenic liver abscess
- Endoscopic retrograde cholangiogram of the bile ducts
- Patients at increased risk of hepatic abscess
- Treatment of pyogenic liver abscess
- Gas-containing liver abscess on CT and ultrasound
- Amebic liver abscess
- Diagnosis and treatment of amebic liver abscess
- Echinococcal (hydatid) cyst of the liver
- Hydatid cysts in liver and lung
- Management of hydatid cysts of the liver
- Surgery for hydatid cysts of the liver
- Simple cysts of the liver
- Unroofing of symptomatic giant cysts
- Biliary cystadenoma and cystadenocarcinoma
- Cystic lesions found in the liver
Benign and malignant primary liver tumours
Lesions that start in the liver itself
- Incidentally discovered solid benign tumours
- Cavernous haemangioma under the microscope
- Indications for resection of benign liver tumours
- Technical feasibility is not an indication
- Hepatic adenoma: rupture and malignant change
- Management of hepatic adenoma
- Hepatocellular carcinoma worldwide
- 0.5-1 M
- Chronic liver injury behind hepatocellular carcinoma
- Cut surface of a liver bearing a large tumour
- Arterial and portal venous phase CT of the liver
- Surgical treatment options in hepatocellular carcinoma
- Choosing between the surgical options
- Survival after resection and transplantation
- Reasons for exclusion from surgical treatment
- Outcome without surgical treatment
- Screening and prevention of hepatocellular carcinoma
- Hepatitis C and systemic therapy for advanced disease
- Cholangiocarcinoma: sites of origin
- Pale tumour at the confluence of the bile ducts
- Relation of tumour to hilar structures
- Caudate resection in hilar cholangiocarcinoma
- Lymph node resection and adjuvant therapy
- Extent of liver resection for cholangiocarcinoma
Hepatic colorectal metastases
Resection, hepatic artery pumps and tumour ablation
- Commonest indication for liver resection by region
- Evidence base for resecting colorectal liver metastases
- Liver replaced by multiple rounded masses on CT
- Liver quality before major resection
- Straight to resection or chemotherapy first
- Conversion of unresectable disease
- Trial enrolment in metastatic colorectal cancer
- ~33%
- Sources of improved survival
- Resection margins in colorectal liver metastases
- Preoperative portal vein embolization
- Timing of surgery after portal vein embolization
- Staged hepatic resection
- Intraoperative ultrasonography of the liver
- Handling tumours found during the operation
- Devices used for liver transection in practice
- Hepatic artery infusion pumps
- Results and toxicity of hepatic artery infusion
- Current place of hepatic artery infusion therapy
- Thermal tumour ablation
- Resection versus ablation in resectable disease
- Limits of thermal ablation
- Ablation near major hilar structures
- Combining resection with ablation
Summary
What the author wants remembered
- Infections and benign lesions
- Primary and metastatic liver tumours
- Sources named in the text
- Maingot's Abdominal Operations, 12th Edition