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PubMedDate not supplied

Effects of prostaglandin E1 administration during hepatectomy for cirrhotic hepatocellular carcinoma.

BACKGROUND/AIMS: Prostaglandin E1 has been used in hepatectomy based on a few limited clinical studies suggesting that PGE1 improves liver function. The aim of this study was to evaluate the effects of PGE1 administration during hepatectomy for cirrhotic hepatocellular carcinoma. METHODOLOGY: Forty-three patients undergoing hepatectomy for cirrhotic hepatocellular carcinoma were divided into 2 groups: hepatectomy with Prostaglandin E1 treatment (PG group; n = 19) and without Prostaglandin E1 treatment (control group; n = 24). Prostaglandin E1 (0.02-0.07 microgram/kg/min) was administered intravenously from beginning to end of surgery in the PG group. RESULTS: There were no significant differences between groups with respect to age, gender, preoperative liver and renal function, or intraoperative variables such as blood loss, weight of resected liver and total clamping time by the Pringle maneuver. No patient had severe postoperative complications. Initial postoperative maximum concentrations of serum total bilirubin, creatinine, and blood urea nitrogen in the PG group were significantly lower than those in the control group. CONCLUSIONS: Prostaglandin E1 administration during hepatectomy for cirrhotic heptocellular carcinoma resulted in improved renal and hepatic function.

Aged↗
PubMed2000

Laparoscopic-assisted hepatectomy (LAH) for the treatment of hepatocellular carcinoma.

The treatment of hepatocellular carcinoma associated with liver cirrhosis necessitates local therapy in some patients because of severe hepatic dysfunction. Percutaneous ethanol injection therapy, the local therapy for such cancer of the liver, and percutaneous microwave coagulation therapy are detailed. The significant disadvantages of these procedures is their inability to evaluate precisely whether the tumor will develop complete necrosis after treatment because the cancer tissue cannot be excised with use of these procedures. Conversely, laparoscopic hepatectomy, which is minimally invasive surgery, has a disadvantage, that is, its difficulty in complex maneuvers, including hemostasis, ligation, and suture. The authors developed laparoscopic-assisted hepatectomy, which is hepatectomy by small incision during laparotomy with the use of laparoscopic observation. This report describes laparoscopic-assisted hepatectomy, which may allow the solving of problems with percutaneous ethanol injection therapy, percutaneous microwave coagulation therapy, and laparoscopic hepatectomy.

Aged↗
PubMedDate not supplied

The remnant liver dysfunction after 84% hepatectomy in dogs.

BACKGROUND/AIMS: We have been investigating the mechanism of remnant liver dysfunction after extensive hepatectomy in a canine model since 1990. This study focused on the role of heat shock protein and hepatocyte apoptosis. METHODOLOGY: Adult mongrel dogs were randomly divided into 3 groups: Group 1, sham operation; Group 2, 70% hepatectomy; and Group 3, 84% hepatectomy. Heat shock protein and hepatocyte apoptosis after hepatectomy were examined by using isolated hepatocytes and Kupffer cells. RESULTS: Heat shock protein significantly increased in Groups 2 and 3, but rose much higher in Group 3. Examination of pure hepatocyte culture showed no apoptosis in Group 2, but significant apoptosis occurred in Group 3. In co-cultures of hepatocytes and Kupffer cells, induction of apoptosis in Group 2 was mild, but it increased earlier and reached very high levels in Group 3. The TNF-alpha level in co-culture supernatant was significantly higher in Group 3 than Group 2. CONCLUSIONS: After extensive (84%) hepatectomy, apoptosis signal transduction predominates over anti-apoptosis signal transduction, despite high expression of heat shock protein in the remnant liver. Accordingly, the cytotoxic mechanism overcomes the cytoprotective mechanism, leading to significant induction of hepatocyte apoptosis and severe liver damage.

Animals↗
PubMedDate not supplied

Cytokine response to human liver ischemia-reperfusion injury during hepatectomy: marker of injury or surgical stress?

BACKGROUND/AIMS: The aim of this study was to evaluate the inflammatory or antiinflammatory cytokine response to ischemia-reperfusion during hepatectomy and to find a useful marker of injury or surgical stress during hepatic ischemia-reperfusion. METHODOLOGY: In 9 patients with liver disease who underwent hepatectomy using the Pringle maneuver, serum cytokines, including alanine transaminase, aspartate transaminase, and hyaluronic acid, were measured just prior to vascular occlusion; 5, 10 and 15 min after initial clamping; and 3 min after initial declamping. RESULTS: The mean concentrations of aspartate transaminase and alanine transaminase did not significantly differ before and after ischemia-reperfusion during hepatectomy. However, mean concentrations of hyaluronic acid after ischemia-reperfusion were significantly (P < 0.03) higher than before clamping. Although there were no significant differences in the mean concentrations of IL-1 beta, IL-6, IL-8, IL-10 and TNF-alpha among, before and after ischemia-reperfusion, the mean concentrations of granulocyte colony-stimulating factor after ischemia-reperfusion and macrophage colony-stimulating factor after reperfusion were significantly (P < 0.05) higher than before clamping. CONCLUSIONS: Although hepatic parenchymal cell function was maintained after ischemia-reperfusion during hepatectomy, sinusoidal endothelial cell dysfunction was found. Release of granulocyte colony-stimulating factor and macrophage colony-stimulating factor after ischemia-reperfusion were also found. These cytokines and hyaluronic acid may be useful indicators in the early phase of human ischemia-reperfusion injury during hepatectomy.

Aged↗
PubMedDate not supplied

Methods and related drawbacks in the estimation of surgical risks in cirrhotic patients undergoing hepatectomy.

There has been a dramatic improvement in recent results of hepatectomy for hepatocellular carcinoma in cirrhotic patients. Hospital mortality rates of less than 5% are frequently reported. The improvement is largely a result of better techniques and performance of surgeons in hepatectomy, and reduction in blood loss and transfusion requirement. Better selection of patients is perhaps a more significant contributory factor. Careful identification of risk factors related to the medical condition of the patient, functional reserve of the liver and volume of the remnant liver is essential for the prevention of postoperative liver failure. Indocyanine green clearance test is the most accurate test for assessment of liver function reserve. An indocyanine green retention rate of 14% at 15 minutes is the safety limit for major hepatectomy for cirrhotic patients. A maximum of 60% of the nontumorous liver can be resected safely. Computed tomography is therefore an important assessment parameter. The liver function reserve also reveals the suitability for hepatectomy. Liver enzymes, alanine aminotransferase or aspartate aminotransferase can reflect the hepatic activity, which could be responsible for the impaired liver function. Steatosis is another factor that influences hepatic function reserve. Age is also an important risk factor in hepatectomy because elderly patients may harbor occult heart disease, reduced respiratory and liver function reserves. After recognizing the risk factors, surgeons should eliminate operative morbidity and mortality by making appropriate decisions based on the assessments. In conclusion, preoperative risk assessment involves evaluation of hepatic function reserve, remnant liver volume, liver status, age and the medical condition of the patient. A 0% hospital mortality rate is considered the objective.

Age Factors↗
PubMedDate not supplied

Quality of life after hepatectomy in patients with hepatocellular carcinoma: implication of change in hepatic protein synthesis.

BACKGROUND/AIMS: Surgical removal has been accepted as a therapeutic option for hepatocellular carcinoma. However, little is known about the quality of life after hepatectomy for hepatocellular carcinoma. In this report, we describe the risk factors most affecting impaired quality of life after partial hepatectomy in patients with hepatocellular carcinoma. METHODOLOGY: Ninety-six patients who received curative resections 12-60 months previously, answered our original questionnaire, mailed to them. The questions consisted of 14 items concerning physical function, social function, psychological function, physical sensation, and recognition of the disease, with a scoring system of 1, 2, and 3. Based on the pre- and postoperative serum alanine aminotransferase or cholinesterase levels at 3-month intervals during the follow-up period, the changes were classified into three types: those staying in the favorable or unfavorable range at one year (no change, Type 1 or Type 3), and those entering the unfavorable range postoperatively (Type 2). RESULTS: Total quality of life score: the sum of scores to questions 1-12, displayed two peaks of normal distribution. Based on a point of intersection of the two curves: i.e., score of 22, the patients were classified into 2 groups: those with preserved quality of life (n = 75) i.e., total quality of life scores of 12-21, and impaired quality of life, scores of 22 or more (n = 21). Older age (> or = 65 y) at hepatectomy, in the course of treatment for recurrence, and Type 2 change of serum cholinesterase level were associated with the impaired quality of life. Multivariate analysis revealed that Type 2 change of serum cholinesterase levels was an independent risk factor for an impaired quality of life. Furthermore, the patients exhibiting Type 2 change of serum cholinesterase levels were clearly impaired in their physical and social functions compared to the other patients. Hepatitis-related or cancer-related factors showed no correlation with the deterioration of the quality of life. CONCLUSIONS: The quality of life after hepatectomy in patients with hepatocellular carcinoma was impaired in cases of aged patients, treatment for recurrence, and Type 2 change of the serum cholinesterase level. Postoperative maintenance of protein synthesis including cholinesterase is one measure to preserve a satisfactory quality of life after hepatectomy.

Adult↗
PubMedDate not supplied

Practical usefulness of bipolar scissors in hepatectomy.

BACKGROUND/AIMS: Because less surgical stress might preserve quality of life of patients, it is more desirable to decrease both intraoperative blood loss and liver injury especially in hepatectomy. For the patients with hepatocellular carcinoma based on chronic liver dysfunction, it is more essential to control bleeding and reduce liver injury in hepatectomy than in other diseases. In the present study, a retrospective comparison about usefulness was made in hepatectomy between using bipolar scissors and using conventional procedure. Before 1997, in our hospital, we had dissected the liver by using the crushing clamp method in combination with cauterization by microwave coagulator for the purpose of reducing intraoperative blood loss. Since 1998, bipolar scissors have been introduced toward hepatectomy as a new, simple and easy device to use. METHODOLOGY: Fifty-three consecutive patients with primary hepatocellular carcinoma at TNM stage I/II who underwent partial hepatectomy between 1996 and 1999 were enrolled in the study. Thirty-two patients (1996-1997) were treated by using a conventional method (group CM) and 21 patients (1998-1999) were treated by using bipolar scissors (group BS). The factors related to surgical stress were compared between the two groups. RESULTS: The amounts of blood loss/transfusion were lower in group BS (641/100 mL) than in group CM (1112/450 mL). The percentages of patients who lost more than 1000 mL of blood were lower in group BS (19%) than in group CM (47%) (P = 0.04). An intraabdominal drainage was needed for 9.0 +/- 6.6 days in group BS, and the drainage period was shorter than that in group CM (15.0 +/- 8.7 days) (P = 0.01). CONCLUSIONS: These results indicated the superiority of bipolar scissors in decreasing blood loss and liver injury to the conventional method, suggesting the worth of performing the prospective randomized study.

Aged↗
PubMedDate not supplied

Surgical treatment of pulmonary recurrence after hepatectomy for colorectal liver metastases.

BACKGROUND/AIMS: Although pulmonary recurrence is frequent among the extrahepatic recurrences after hepatectomy, the efficacy of surgical treatment for pulmonary recurrence after hepatectomy has not been confirmed. Surgical resection of pulmonary recurrence after hepatectomy for colorectal metastases was reviewed retrospectively to evaluate the survival benefit. METHODOLOGY: From 1990 to 1995, 10 of the 17 patients with pulmonary recurrence after hepatectomy for colorectal metastases underwent surgical treatment. Ten patients underwent resection of pulmonary recurrence. RESULTS: Operative mortality was 0%, and a postoperative complication was observed in 1 patient after pulmonary metastasectomy. The overall 5-year survival rate after pulmonary metastasectomy was 10.0%, and the median survival was 21.7 (range: 2.4-77.9) months. One patient underwent resection two times for remnant lung recurrence after first lung metastasectomy, and is alive with no evidence of recurrence 77.9 months after the first pulmonary resection, and 50.7 months after the third pulmonary resection. In 3 patients with well-differentiated adenocarcinoma, the median survival time was 6.2 months (range: 2.4-9.7). The other hands, 7 patients with moderately differentiated adenocarcinoma have a longer median survival time of 29.2 months (range: 16.0-77.9). CONCLUSIONS: Pulmonary metastasectomy after hepatectomy for metastases from colorectal cancer is a safe treatment, and might offer prolonged survival for highly selected patients.

Adenocarcinoma↗
PubMed1992

[Pathophysiology and management of patients with diabetes mellitus in gastrointestinal surgery, with special reference to hepatectomy and pancreaticoduodenectomy].

In the 235 patients with hepatectomy, 111 with pancreaticoduodenectomy (PD) and 547 with gastrectomy for the past 15 years and 5 months, we compared the incidence of postoperative complications between patients with diabetes mellitus (DM) and those without DM, and studied glucose metabolism and management of diabetic patients. DM was most frequently found at 27.7% in hepatectomy, especially 38.7% in cirrhotic patients, followed by 24.3% in PD and only 5.9% in gastrectomy. The incidence of postoperative complications was not different between DM and non-DM after gastrectomy and PD. It was significantly higher in DM than in non-DM after hepatectomy (38.5% vs. 11.8%), although there was no statistically significant difference in the cirrhotic patients with hepatectomy (34.9% vs. 23.5%). The studies on insulin metabolism preoperatively determined by oral glucose tolerance test and postoperative control of DM revealed that diabetic patients with hepatectomy, especially hepatogenous DM, had a significantly reduced insulin uptake in the liver and exogenous insulin resistance to glucose. After PD for diabetic patients, a long-term care of impaired pancreatic exocrine and endocrine functions was considered to be required, especially paying attention to lipid and zinc metabolism.

Diabetes Complications↗
PubMed2003

[Significance of intracellular cytokines levels in peripheral lymphocytes for evaluation of surgical stress after hepatectomy in patients with hepatocellular carcinoma].

It is difficult to evaluate surgical stress of patients with hepatocellular carcinoma (HCC). Cytokine production from the liver is decreased due to the liver dysfunction that is usually associated with HCCs. Therefore, we evaluated surgical stress after hepatectomy by measuring intracellular cytokines of lymphocytes in peripheral blood. We examined 22 patients with digestive cancers (8 with HCC, 10 with gastric cancer, and 4 with esophageal cancer). The concentrations of serum IL-6 levels 6 h after hepatectomy, gastrectomy, and esophagectomy were 268 +/- 84, 309 +/- 93, and 1,323 +/- 364 pg/ml, respectively. There was no significant difference between hepatectomy and gastrectomy, though based on clinical observations, it is estimated the surgical stress of hepatectomy was greater than that of gastrectomy. Conversely, the percentage of CD4+IL-6+ cells 6 h after surgery was 8.5 +/- 2.8, 3.3 +/- 0.6, and 7.8 +/- 3.4%, respectively. The percentage of CD4+IL-6+ cells after hepatectomy was significantly higher than that after gastrectomy. We estimated that the percentage of CD4+IL-6+ cells was an appropriate indicator of surgical stress on HCC, because the percentage of CD4+IL-6+ cells correlated well with the duration of surgery more than did the serum IL-6 levels. These results suggest that the percentage of CD4+IL-6+ cells may help in accurately evaluating surgical stress in patients with liver dysfunctions such as HCC.

CD4-Positive T-Lymphocytes↗
PubMedDate not supplied

Resection of localized recurrences after hepatectomy of colorectal cancer metastases.

BACKGROUND/AIMS: Hepatectomy is generally considered the only mode of curative treatment available for patients with colorectal liver metastases, even though recurrence occurs in more than 60% of the patients. METHODOLOGY: This is a retrospective study examining the survival of 11 patients undergoing surgical excision of recurrences gained from 46 patients undergoing initial hepatectomy for metastatic colorectal cancer. These 46 patients had curative hepatectomy and no extrahepatic metastasis. RESULTS: Cancer recurred in 29 of the 46 patients after a median follow-up time of 29.5 months (range 2-183 months), and 11 had curative resection of localized recurrences. In 6 patients, the liver was the only site of recurrence and 4 patients had isolated lung metastases. One patient had liver and lung metastases. There was no perioperative mortality. The median survival time and cumulative 5-year survival rate for 11 patients after the repeated resection were 28 months and 43.8%, respectively. These results were comparable to the survival for 46 patients after the initial hepatectomy, in which the median survival was 29.5 months and the 5-year survival rate was 49.0%. CONCLUSIONS: In appropriately selected patients with colorectal cancer, surgical excision of localized recurrences after hepatectomy may be effective in prolonging survival.

Aged↗
PubMedDate not supplied

Usefulness of biodegradable absorbable rib connecting pins in thoracoabdominal hepatectomy.

BACKGROUND/AIMS: Some patients who undergo thoracoabdominal hepatectomy suffer from pain and discomfort after because rib and/or costal cartilage was cut during the operation. The usefulness of absorbable rib connecting pins in thoracoabdominal hepatectomy was evaluated. METHODOLOGY: Of 18 patients who underwent thoracoabdominal hepatectomy, the stumps of ribs were not fixed in 9 patients (group 1) and the stumps of ribs were fixed with the rib connecting pins in 9 other patients (group 2). We evaluated the usefulness of these pins in thoracoabdominal hepatectomy. RESULTS: In 8 patients in group 1 and 2 patients in group 2, pain continued for 1 month after the operation (p = 0.015). At 2 months after the operation, pain continued in 6 patients in group 1 and no patients in group 2 (p = 0.009). At 6 months after the operation, 2 patients in group 1 still had pain. Rib instability continued in 8 patients in group 1 at 6 months after the operation, although rib instability disappeared by 2 months after the operation in all group 2 patients (p = 0.0004). CONCLUSIONS: Biodegradable absorbable pins for rib fixation are useful for preventing pain and discomfort around the cut stumps of ribs in thoracoabdominal hepatectomy.

Absorbable Implants↗
PubMed1992

Effect of triiodothyronine on rat liver polysome profiles and translational activity of mRNA after partial hepatectomy.

The administration of 3,5,3'-L-triiodothyronine (T3) (200 micrograms/100 g) to rats immediately after partial hepatectomy led to an increase in total polysome content of residual hepatocytes (as measured 18 h postoperatively) which exceeded that observed after partial hepatectomy in the absence of hormone. The percentage of free ribosome pool remained the same after partial hepatectomy irrespectively on the absence or presence of T3. After partial hepatectomy the sedimentation pattern of total polysomal fraction (isolated 18 h postoperatively) shifted towards smaller aggregates as compared with that isolated from sham operated animals. T3 did not affect this pattern. The translational capacity of mRNA isolated from regenerating liver after 18 h was higher than that of mRNA isolated from sham operated animals. T3 increased the translational capacity of mRNA isolated from regenerating liver if administered immediately after surgery. Two dimensional electrophoresis of translated products showed that one of the typical proteins recently characterized with Mr 25,000 pI 6.9 appeared after partial hepatectomy and was significantly increased when T3 was administered immediately after surgery. These results show that thyroid hormone can enhance some of the characteristics features of liver regeneration involved in the synthesis of proteins typical for the process of liver regeneration.

Animals↗
PubMedDate not supplied

The liver as a potential hematolymphoid organ examined from modifications occurring in the systemic and intrahepatic hematolymphoid system during liver regeneration after partial hepatectomy.

In order to investigate whether or not the adult murine liver can function as one of the hematolymphoid organs, we studied the alteration of cellular characteristics in the systemic and intrahepatic hematolymphoid systems during liver regeneration after partial hepatectomy. Liver regeneration affects the systemic hematolymphoid system, as can been seen from the transient increase in colony forming unit in culture (CFU-C) frequency observed in the bone marrow at 20 hr and its gradual increase in the spleen up to the 6th day after partial hepatectomy. CFU-C were found not only in peripheral blood lymphocyte-rich fraction (PBL), but also in intrahepatic lymphocyte-rich fraction (IHL) of the normal adult liver. CFU-C frequency showed a weak increase in PBL and a dramatic increase, up to the 6th post-hepatectomy day, in IHL subfraction cells, forming a very strong liver association. Colonies, which were generated from IHL in a fibrin clot culture system, were mainly composed of granulocytes, macrophages and mast cells. Wheat germ agglutinin (WGA) positive cells too were detected in IHL and found to increase after partial hepatectomy. IHL of the normal liver were proliferated not only by IL-3 and GM-CSF but also by IL-2. The proliferative responses of IHL to these cytokines were further augmented on day 6 after partial hepatectomy. Similar results were obtained in peripheral blood and splenic lymphocyte-rich fractions. These observations, therefore, suggest that the adult murine liver has hematolymphoid cells as its component and has the function of a hematolymphoid organ closely associated with the systemic hematolymphoid system.

Animals↗
PubMed2005

[Laparoscopic hepatectomy by curettage and aspiration: 54 cases reported].

OBJECTIVE: Introduce the experience on 54 cases of laparoscopic hepatectomy-liver transection by curettage and aspiration (LTCA). METHODS: We used Peng multifunctional operative dissector (PMOD) to perform laparoscopic liver transection by curettage and aspiration. RESULTS: 52 patients underwent laparoscopic hepatectomy successfully. 2 patients were converted to an open hepatectomy for raw surface hemorrhage or severe abdominal cavity adherence. Mean operative time was 146.5 minutes, the mean bleeding volume was 460 mL, the largest excised liver size was 20 cm x 7 cm x 4 cm. Bile leakage and pneumothorax occurred in 2 patients. Patients could walk one day after operation and were discharged one week postoperatively. CONCLUSION: Laparoscopic hepatectomy by curettage and aspiration is a safe and effective technique. PMOD is an optimal tool to perform laparoscopic hepatectomy.

Adult↗
PubMed1992

Hepatectomy accelerates the growth of transplanted liver tumor in mice.

To study the effect of hepatectomy on the growth of liver tumor, Shionogi Carcinoma 42, a mammary tumor, was transplanted into the liver of mice which had undergone 40% hepatectomy. The liver tumor and the number of pulmonary metastases in hepatectomized mice were significantly larger than those in nonhepatectomized mice. Responses to lectins and IL-2, subpopulations, and cytotoxicity to YAC-1 and P815 cells of splenocytes were assessed to evaluate immunological status. At the initial phase after hepatectomy and tumor transplantation into the remaining liver, NK activity transiently increased, and function of B and T cells, especially of helper T cells, decreased, while B-cell function recovered beyond normal levels in a later phase. These results suggest that liver may play an important immunological role and that the immunological modification after hepatectomy may be responsible for the accelerated growth of liver tumor. Accordingly, some adjuvant immunotherapy may be recommended for the prevention of recurrence after hepatectomy for liver tumor.

Alanine Transaminase↗
PubMed2006

[Recovery from propofol anesthesia is delayed in hepatectomy patients due to altered pharmacodynamics].

BACKGROUND: Liver dysfunction has major impacts on the pharmacokinetics and pharmacodynamics of anesthetics. This study was designed to evaluate propofol concentrations during and at the end of total intravenous anesthesia (TIVA) for hepatectomy. METHODS: Fifty patients receiving hepatectomy (n = 25) or other epigastric surgeries (controls, n = 25) were anesthetized with TIVA. Fentanyl was injected repeatedly to insure maintenance of the effect-site concentration in the 2.0 to 2.5 ng x ml(-1) range with off line computer similation program. Propofol was administered with target-controlled infusion at the initial target concentration of 3.0 mcg x kg(-1), and then titrated to maintain bispectral index (BIS) values between 40 and 50. The intervals after propofol discontinuation to emergence and extubation and the predicted propofol and fentanyl concentrations were recorded. Propofol concentrations at emergence were measured with blood sample in eight cases. RESULTS: The propofol dose in hepatectomy patients as well as both measured and predicted concentrations of propofol at extubation, were lower than in control patients. The extubation time was longer in hepatectomy than in control subjects. CONCLUSIONS: Recovery from TIVA is delayed in hepatectomy patients. We speculate that this is attributable to altered pharmacodynamics in these patients.

Aged↗
PubMed2006

Living donor hepatectomy (LDH)--comparative study between two different anesthetic techniques.

BACKGROUND: Living donor hepatectomy (LDH) is now widely used to meet the need for liver grafts due to the shortage of cadaveric livers. Donor safety and perioperative anesthetic management are our major concern. The aim of our study was to compare two anesthetic techniques for management of living donor hepatectomy. PATIENTS & METHODS: After ethical committee approval and informed written consent, 20 donors ASA I physical status undergoing hepatectomy for living-relative liver transplant were allocated randomly to one of two groups. Group A where anesthesia was induced with fentanyl 2 microg/kg and propofol 2-3 mg/kg(-1), and maintained with isoflurane 0.8-1.2% and fentanyl infusion 1-2mcg/kg(-1)/h(-1). In group B anesthesia was induced with sufentanyl 0.2mcg/kg(-1), and propofol 2-3mg/kg(-1), and maintained with propofol infusion 6-12 mg/kg(-1)/h(-1), and sufentanyl infusion 0.2-0.4mcg/kg(-1)/h(-1). Atracurium was the muscle relaxant for intubation and maintenance in both groups. RESULTS: There were no perioperative mortality in both groups, no significant statistical differences between both groups as regard demographic data, duration of surgery, duration of anesthesia, hospital stay, intraoperative hemodynamics, blood loss, liver function tests (PT, AST, & ALT) measured in the first, third, and seventh days postoperative. CONCLUSION: In conclusion, our study demonstrated that both anesthetic techniques were well tolerated for living donor hepatectomy, with no blood transfusion required, with short and safe discharge from PACU and short hospital stay, but with significant laboratory changes reflecting transient impairment in metabolic liver function. These procedures have proven useful as an important alternative to the cadaveric liver transplantation. Both techniques can be used as fast tract technique for living donor hepatectomy.

Adolescent↗