Prevention of gastric stasis by omentum patching after living donor left hepatectomy.
ABSTRACT Among 137 living liver donors who underwent partial hepatectomy between August 1997 and November 2010, 58 donated the left lobe of their liver, with or without the caudate lobe. Gastric stasis developed after surgery in 4 (7 %) of these 58 donors (Fig. 1); possibly because of dislocation of the stomach after hepatectomy and adhesion between the stomach and the cut surface of the liver. This complication is specific to left hepatectomy  and although not life-threatening, it is symptomatic and requires endoscopic or surgical intervention. We describe our surgical technic designed to prevent this complication. Fig. 1 Gastric stasis after living donor left hepatectomy. Fluorescent imaging study shows an enlarged stomach with no passage of radiofluorescence through the pylorus.
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ABSTRACT: Delayed gastric emptying is a significant postoperative complication of living donor hepatectomy for liver transplantation and may require endoscopic or surgical intervention in severe cases. Although the mechanism of posthepatectomy delayed gastric emptying remains unknown, vagal nerve injury during intraoperative dissection and adhesion formation postoperatively between the stomach and cut liver surface are possible explanations. Here, we present the first reported case of delayed gastric emptying following fully laparoscopic hepatectomy for living donor liver transplantation. Additionally, we also present a case in which symptoms developed after open right hepatectomy, but for which dissection for left hepatectomy was first performed. Through our experience and these two specific cases, we favor a neurovascular etiology for delayed gastric emptying after hepatectomy.
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ABSTRACT: BACKGROUND: Delayed gastric emptying (DGE) is a common complication following left-sided hepatectomy. The goal of this study was to clarify the clinical implications of an omental flap wrapping procedure that includes fixation to the cut surface of the liver to reduce the incidence of DGE after left-sided hepatectomy. METHODS: The study included 50 consecutive patients who underwent left-sided hepatectomy between January 2000 and July 2011. Clinicopathologic risk factors for DGE after left-sided hepatectomy were identified using univariate and multivariate models. The incidence of DGE, digestive symptoms, and postoperative complications were compared between two groups: 25 patients treated with the omental flap wrapping and fixation procedure and 25 patients who did not receive such a flap. RESULTS: A univariate analysis revealed that a lack of the omental flap, the lymph node clearance, and use of left hemihepatectomy were associated with postoperative DGE. The multivariate analysis indicated that the lack of the omental flap was the only independent significant factor associated with the DGE (odds ratio, 21.23; p = 0.0002). There was a significant difference in the incidence of DGE between the patients with (4 %) and without an omental flap (36 %). The incidence of gastric distension and the use of prokinetic drugs were also significantly lower in patients with an omental flap than in patients without the flap, and patients with an omental flap resumed a solid diet significantly earlier. CONCLUSIONS: This retrospective single-center study revealed that it was possible to reduce the incidence of DGE using a procedure involving omental flap wrapping with fixation to the cut surface of the liver after left-sided hepatectomy.Surgery Today 12/2012; 43(12). DOI:10.1007/s00595-012-0446-8 · 1.21 Impact Factor