CC BY
65. V.M. Hasanov. Therapeutic dentistry. Diseases of the hard tissues of the tooth, Baku 2012, p. 69
6. R.M. Mammadov, R.K. Gasimov, K.L. Asla-nov. Propedeutics of therapeutic dentistry. Baku - 2011, p.112
7. N.V. Kuryakina. Therapeutic pediatric dentistry, Moscow, 2004, p. 372-273.
8. Mammadov F.Y., Safarov A.M., Yusubova Sh.R. Therapeutic Dentistry part 1, Baku 2012, p.41
NONSPECIFIC MORBIDITY IN ANATOMIC AND ATYPICAL LIVER RESECTIONS
Rusenov D.
Dr., MD Clinic of Liver-biliary,
Pancreatic and General Surgery Acibadem City Clinic Tokuda Hospital EAD
Sofia
DOI: 10.5281/zenodo.7513843
Abstract
Liver resection remains one of the most technically challenging surgical procedure in abdominal surgery due to the complex anatomical arrangement in the liver
The development of new operative instruments, and surgical techniques, increased knowledge of liver anatomy and pathophysiology after hepatectomy, and more precise patient selection have contributed to the reduction of postoperative complications.
The precise assessment of both liver resection and liver function is critical in surgical management, as the balance between the operative procedure and residual liver function is the most important concern in patients.
Keywords: liver resections, complications after liver resections, nonspecific morbidity.
The historical development of liver resection surgery has been linked to a number of studies and discoveries concerning anatomy, physiology, tolerance to ischemia, parenchymal dissection techniques and reliable hemostasis and biliostasis, advances in anesthesiology and resuscitation, and pharmacology.
Despite centuries of interest in the anatomy of the liver and its pathology, the first Francis Glisson (15971677), a British physician and anatomist, described in detail in Anatomia Hepatis the structure of the largest parenchymal organ in the human body.
Francis Glisson (1597-1677) „Anatomia Hepatis"
A relatively new concept of the device and especially the vascular architecture of the liver is presented by Hugo Rex (1888) and James Cantlie (1897).
line of Rex-Cantlie
The above-mentioned authors and their studies have undoubtedly laid the anatomical foundations for the onset of liver surgery, although the concept of functional anatomy of the liver has not yet been established. This predetermines the failure of a huge percentage of interventions, but it is still right to pay due attention to the pioneers in the liver surgery. INTRODUCTION:
Liver resection surgery is an indicator of the level of each surgical structure. It is a challenge not only to surgical teams, but also to many other doctors -anesthesiologists-resuscitators, interventional
gastroenterologists, hepatologists, pathologists, imaging specialists, clinical oncologists and many other specialties. Thus, liver surgery is a vivid and convincing example of a multidisciplinary approach in the treatment of oncological diseases of the liver. OBJECTIVE:
On the basis of the overall statistically processed information, we wish to formulate conclusions about the existence of factors with prognostic significance for the occurrence of specific complications. If such prognostic factors are eventually established, consideration of them in our future work and their promotion among the surgical community at national and international scientific forums in order to improve early postoperative outcomes.
MATERIALS AND METHODS: For the period from January, 2007 - March, 2018 in Clinic of liver, biliary pancreatic and general surgery, Acibadem City Clinic Tokuda Hospital ,1021 interventions were performed on the liver:
_ for different indications, and different types of procedures;
U in varying volume and varying degrees of complexity;
n with different technical characteristics.
A single-center, retrospective study was conducted.
Cases of intervention other than liver resection by definition were excluded ISGLS, "removal of part of the liver parenchyma due to involvement by a disease process or traumatic injury resulting in devitalization of the parenchyma".
Thus, the study did not find the cases of:
L hepatotomy;
r cystotomies and cyst resections, practically without removal of functioning or pathologically altered liver parenchyma;
liver biopsies, alcoholization of tumors. liver biopsies, alcoholization of tumors;
r interruption of trunk branches of the hepatic artery and/or portal vein with the aim of hypoperfusion of a given area (segments, lobe);
L suture of the liver in trauma;
Thus, a total of 852 cases of liver resections were included in the series
RESULTS:
Any liver resection, as a "surgery" can lead to general (non-specific) and specific complications. [1,2] The former include suppuration of the operative wound, deep phlebothrombosis, pulmonary thromboembolism, bronchopneumonia, cardiac complications (rhythmic, conductive, ischemic), decompensation of existing diabetes mellitus with/without ketoacidosis. [2,3,4]
GENERAL (NON-SPECIFIC) MORBIDITY
Table.1.
Incidence of nonspecific complications after liver resection
Non-specific complications statistics anatomical liver resections atypical liver resections total p
surgical wound complications N 4 6 10 0,668
% 14,8% 6,5% 8,4%
Cardiovascular N 2 13 15
% 7,4% 14,1% 12,6%
Pulmonary N 12 40 52
% 44,4% 43,5% 43,7%
inflammatory N 2 8 10
% 7,4% 8,7% 8,4%
Other (hemorrhage from GIT, uroinfection, allergic reaction) N 7 25 32
% 25,9% 27,2% 26,9%
total N 27 92 119
% 100,0% 100,0% 100,0%
DISCUSSION:
We registered general (non-specific) postoperative complications in 119 patients after liver resection (13.9%), of which 27 were registered after Anatomic liver resection, and 92 - after Atypical liver resection. In general, the statistical processing of the data did not establish a relationship between the frequency of these complications on the one hand and the type of liver resection on the other - Anatomic liver resection or Atypical liver resection (table 1).
CONCLUSION:
Non-specific complications in the early postoperative period are a serious problem in all areas of abdominal surgery, especially after "heavy" liver operations, on the background of oncological disease, even more so in multivisceral resections. The downplaying of the importance of this category is dictated mostly by the fact that the treatment almost never requires reoperation, but includes conservative therapy, possibly an interventional procedure. This does not mean that the importance of non-specific complications in liver resection surgery should be downplayed and ignored. On the contrary, in our study, such were the reasons in 52.3% (n=10/19) of the registered exituses.
The respiratory system was most frequently affected - in 44.4% (n=12/27) after anatomical resection and in 43.5% (n=40/92) after atypical liver
resection. Respiratory failure caused death in 4 of our patients.
Serious cardiac problems affected a total of 15 patients - 2 after anatomic resection (7.4% of complications) and 13 after atypical liver resection (14.1%). Despite the far lower absolute number and relative proportion of cardiac complications compared to pulmonary complications, they caused exitus lethalis also in four patients.
References
1. Cantlie J. On a new arrangement of the right and left lobes of theliver. J. Anat. Physiol. Lond. 1898; 32:4.
2. Guido Giglioni, 'Glisson, Francis (1599?-1677)', Oxford Dictionary of National Biography, Oxford University Press, 2004;2006, 31;208
3. H Rex H. Beitrage zur Morphologie der Sa'ugerleber. Morph. Jahrb. 1888; 14:517.
4. Rebecca A., Carlos E. Predictive Indices of Morbidity and Mortality After Liver Resection Ann Surg 2006 Mar; 243(3): 373-379.
5. Rusenov.D Comparative analysis of anatomical and atypical liver resections for the occurrence of specific post-resection complications / nonspecific morbidity. Medical Review, 56, 2020, No. 5, 22-24
