title: Laparoscopic liver resection in patients with a history of upper abdominal surgery.
abstract: BACKGROUND
  The liver is the organ where tumors most frequently metastasize. Hepatic recurrence after resection of hepatocellular carcinoma also occasionally occurs. With the increasing use of laparoscopic surgery for hepatic tumors, there may be a high probability that laparoscopic liver resection can be performed in patients with a surgical history. The purpose of this study was to assess the feasibility and clinical outcomes of laparoscopic liver resection in patients a history of upper abdominal surgery.
  
  
  METHODS
  Of 202 laparoscopic liver resections, 47 patients underwent laparoscopic liver resection after previous upper abdominal surgery between January 2004 and July 2009. Fifty-five previous surgeries were performed in the 47 patients. The previous types of surgical procedures included hepatobiliary and pancreatic (HPB) procedures (n=25) and non-HPB procedures (colorectal malignancies, subtotal gastrectomy, and splenectomy; n=22).
  
  
  RESULTS
  In patients with a history of surgery, the mean operative time for laparoscopic liver resection was 312.3 min and the mean blood loss was 481.0 ml. In 42 patients (89.4%), there were severe adhesions in the hepatoduodenal ligament and hilar areas. Transfusion was required in 7 patients (14.9%). There was one conversion to a laparotomy due to severe adhesions. Complications occurred in 11 patients (23.4%) and the mean hospital stay was 10.6 days. When we compare patients with and without a history of surgery, there were no differences in the above-mentioned perioperative results. However, among patients with a history of surgery, patients who underwent HPB procedures had longer operative times and higher postoperative morbidities than those who had not undergone HPB procedures.
  
  
  CONCLUSIONS
  Laparoscopic liver resection in patients with a history of upper abdominal surgery is feasible and safe.
authors: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
authors: Keun Soo
authors: KS
authors: Ahn
authors: Ho-Seong
authors: HS
authors: Han
authors: Yoo-Seok
authors: YS
authors: Yoon
authors: Jai Young
authors: JY
authors: Cho
authors: Ji Hoon
authors: JH
authors: Kim
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay / Q000639:trends; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome