title: Laparoscopy extends the indications for liver resection in patients with cirrhosis.
abstract: BACKGROUND
  Clinical or biological evidence of liver failure is usually considered a contraindication to open liver surgery as it is associated with a prohibitive risk of postoperative death.
  
  
  METHODS
  This report describes three patients who had resection of a superficial hepatocellular carcinoma suspected either to be ruptured, or at high risk of rupture, using the laparoscopic approach. All three patients had intractable ascites, in two superimposed on active hepatitis. Surgery was per- formed under continuous carbon dioxide pneumoperitoneum with intermittent clamping of the hepatic pedicle.
  
  
  RESULTS
  Intraoperative blood loss was between 100 and 400 ml; no blood transfusion was required. The postoperative course was uneventful except for a transient leak of ascites through the trocar wounds. Duration of in-hospital stay was 6-10 days. Liver function tests had returned to preoperative values within 1 month of surgery in all patients.
  
  
  CONCLUSIONS
  The laparoscopic approach may enable liver resection in patients with cirrhosis and evidence of liver failure that would contraindicate open surgery.
authors.affiliation: Department of Hepato-biliary and Digestive Surgery, Beaujon Hospital, University Paris VII, Clichy, France.
authors.forename: M Y
authors.initials: MY
authors.lastname: Abdel-Atty
authors.forename: O
authors.initials: O
authors.lastname: Farges
authors.forename: P
authors.initials: P
authors.lastname: Jagot
authors.forename: J
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D001201:Ascites / Q000150:complications; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008103:Liver Cirrhosis / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed