TITLE:
Adhesiolysis for Liver Resection in a Patient with a Reconstructed Stomach Tube after Esophagectomy
AUTHORS:
Shigeru Fujisaki, Motoi Takashina, Kenichi Sakurai, Ryouichi Tomita, Tadatoshi Takayama
KEYWORDS:
Detachment of Adhesions, Liver Resection, Reconstructed Stomach Tube
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.11 No.6,
June
11,
2020
ABSTRACT: To our knowledge this is the first report to provide a detailed
description of surgical procedure for adhesiolysis and hepatectomy in patients
who have undergone esophagectomy and reconstruction. We performed a hepatic resection
of the left medial segment in a patient with a reconstructed stomach tube after
esophagectomy for the esophageal carcinoma. The reconstructed stomach tube
overlapped with the left medial segment of the liver and the hepatoduodenal
ligament and was extensively and strongly adhered to them. It is important for
clinicians to know how to perform the detachment procedure successfully in
order to secure a surgical field for liver resection without damaging the
fragile reconstructed gastric tube. In order
to avoid vascular injury of the stomach tube, it was decided that detachment
around the hepatoduodenal ligament preceded detachment of the stomach tube from
the liver. After complete separation of the hepatoduodenal ligament from the
stomach tube, the hepatoduodenal ligament was encircled with tape.
Subsequently, adhesiolysis was performed between the stomach tube and
the liver. Finally, parenchymal transection was performed using the
intermittent hepatic inflow occlusion and crush clamping techniques to dissect
the parenchyma. The patient was discharged two weeks after surgery without
complication.