Central hepatectomy (CH) is also known as mesohepatectomy and means hepatic resection of segments 4, 5, and 89. Hepatic lesions located in these segments may require extensive resections, such as right, left, extended right or extended left hemi-hepatectomies especially due to their relationship to major vascular and biliary structures. CH represents a potential risk of intraoperative bleeding, biliary injury, and risk of positive margins, but also represent the appealing concept of parenchyma sparing, furthermore in benign lesions.
A 61-year old female patient with history of choluria, acholic stools, jaundice and pain in the right upper abdominal quadrant had undergone a cholecystectomy and hepatic cyst unroofing by laparotomy in another institution, 30 months ago. Due to the cholestatic symptoms recurrence, she was refered to our center.
Abdominal MRI showed a cystic lesion in segment 4 with septa and thickened walls, and measuring 9.0 cm. The cyst was demonstrated as isosignal on T1 and hyperintense signal on T2. The confluence of left and right bile ducts was compressed by the cyst, which caused moderate bilateral dilation. The lateral limit of the cyst compressed the left hepatic artery and the left branch of the portal vein, while its lower limit compressed the right portal branch and the right hepatic artery. Other non-complex cystic lesions were scattered through the liver (Figure1). Laboratory tests showed increased canalicular enzymes and bilirubins and negative tumor markers. The case was reviewed at a weekly hepatobiliary multidisciplinary conference and the main hypothesis was a recurred biliary cystadenoma. In order to avoid a right trisectionectomy the decision was to perform a parenchymal preserving resection - central hepatectomy.
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