Bowel injury associated with liver surgery for hepatocellular carcinoma.
OBJECTIVE
Bowel injury associated liver surgery is rare but can be fatal if not adequately treated. The contribution of underlying liver disease and previous hepatectomy to bowel injury in hepatectomy for hepatocellular carcinoma is unknown.


METHODS
Clinical records of 531 patients who underwent hepatic resection without combined resection of the biliary tract or intestine for hepatocellular carcinoma during 13 years were reviewed. Differences in incidence of bowel injury according to presence or absence of liver cirrhosis, technique of hepatectomy, and history of hepatectomy were investigated. Outcome after treatment also was reviewed.


RESULTS
Bowel injury occurred in 5 patients (0.9%). Previous hepatectomy history was associated with an increased incidence of bowel injury [repeat hepatectomy, 3/91 (3.3%), and first hepatectomy, 2/440 (0.5%), p = 0.038]. Injury was recognized intraoperatively in two patients and postoperatively in three. In the former two patients, the injured bowel was repaired immediately but a fistula still developed in one patient. One patient with a fistula eventually required temporary fecal diversion and eventually limited colectomy. The other three patients were treated by continuous external drainage, but two of them required debridement or colic sleeve resection.


CONCLUSIONS
Previous hepatectomy increases the risk for bowel injury during hepatectomy. Care must be taken to prevent adhesion to the hepatic cut surface. Careful use of electrocautery to prevent burn injury also should be taken.
Tanaka
Shogo
S
Department of Hepato-Biliary-Pancreatic and Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. m8827074@msic.med.osaka-cu.ac.jp
Tanaka
Hiromu
H
Kubo
Shoji
S
Shuto
Taichi
T
Takemura
Shigekazu
S
Yamamoto
Takatsugu
T
Uenishi
Takahiro
T
Hai
Seikan
S
Osugi
Harushi
H
Hirohashi
Kazuhiro
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000293:injuries* / Q000473:pathology; D004386:Duodenum / Q000293:injuries* / Q000473:pathology; D005260:Female; D005402:Fistula; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged