Background: Hepatic resection is needed to manage many types of pathology, either malignant or benign. It offers the only potentially curative treatment for many primary and secondary hepatic malignancies. Planning hepatic resection needs to be considered as the nature of the lesion and its location within the liver, the patient's anatomy, and the quality and volume of the liver tissue that will remain after resection. Perioperative outcomes for hepatic resection have improved due to better surgical techniques that take advantage of the segmental anatomy of the liver, improved techniques for control of bleeding, and improved intensive care.
Objectives: To investigate the morbidity in our center—a tertiary care facility with a multidisciplinary team for hepatobiliary diseases and transplantation where the mortality of liver resection is below 1%— as well as to develop a simple score predicting the risks of complication.
Patients and methods: In this prospective study, 52 patients of both sexes, age above 12 years old, with chronic liver diseases due to benign and malignant tumor, were subjected to hepatic resection and postoperative management of biliary complications at the Department of Surgery, National hepatic institute in Egypt.
Results: Regarding our results, we found that postoperatively, there was no deterioration in renal functions; median urea was at a median of 23.1 (19.4 – 27.2), median creatinine level was 0.8 (0.6 – 0.9). There was a slight elevation of both ALT and AST; 84 (68 – 101.5), 84.5 (60.25 – 131.75), respectively. Otherwise, hepatic functions were normal; Median total bilirubin was 1.12 (0.83 – 1.38), median albumin was 3.4 (3.03 – 3.8). In term of postoperative complications, we detected that bile leakage was the most common complication which was prevalent in 13.5% of patients (7 patients). Renal failure occurred only in one case which represents 1.9% of cases. No risk of pulmonary infection, ascites, subphrenic abscess, pleural effusion, biliary stricture, wound dehiscence, intestinal obstruction, intra-abdominal bleeding were recorded among cases. Regarding the biliary complications, we found that bile leakage as a complication of liver resection operations was mutually present between males and females. 13.8% of males (4 patients) vs. 13 % of females, which represents three patients who suffered from biliary leakage. We also found that age was not a significant predictor of biliary complications (P = 0.069).
Conclusion: Postoperative transaminase levels are independent predictors of postoperative morbidity and mortality and therefore are clinically relevant. Transaminase levels usually peak during the first 24 h after surgery and thus possess early prognostic power in postoperative mortality. Elevated liver enzymes represent a risk factor for biliary complications and leakage after hepatic resection.