Two-stage hepatectomy: tape it and hang it, while you can.

Abstract

Two stage hepatectomy is currently a method of choice for the treatment of multifocal bilobar hepatic lesions, especially in the setting of hepatic metastases of colorectal malignancies. We describe a technique that facilitates second-stage hepatectomy by taping the major vascular structures of the right liver and performing a hanging maneuver during the first stage. At the first-stage hepatectomy, the right hepatic artery and the right portal branch are dissected free and taped with color-coded silicone tapes. A classic hanging maneuver is performed using a silicone loop. These three loops are left in situ until the second-stage hepatectomy. During the second-stage hepatectomy, the presence of the vascular tapes appears a major aid in the subsequent dissection and control of the major vascular structures, and the hanging loop helps parenchymal section and surgeon orientation, without liver mobilization. Six patients underwent this procedure. In one patient a biliary leak developed after the first-stage procedure, and this required reoperation for drainage. Although there is a risk of thrombosis in this setting, there were no vascular complications related to the tape positioning, nor was there any incidence of infection related to the use of the silicone tape. The technique described here has been in regular use in our department since 2009, and in our experience, it may facilitate second-stage hepatectomy.