Laparoscopic liver resection: initial experience in a North-African single center.

BACKGROUND

Over past decades laparoscopic liver resection (LLR) has gained wide acceptance among hepatobiliary surgeons community. To date, few data are available concerning LLR programs in developing countries. This study aimed to assess feasibility and safety of LLR in a Moroccan surgical unit.

METHODS

From June 2010 to February 2013, patients that received LLR were identified from a prospective "liver resection" database and included in this study. Parenchymal transection was performed using Harmonic scalpel and bipolar clamp with no Intraoperative ultrasound use or systematic pedicle clamping. LLR difficulty was categorized into 3 categories according to Louisville-statement (I-III). Demographic informations, liver lesion informations, operative details, pathological tumor-margin and 1-months postoperative morbidity according to Clavien-Dindo(C-D) classification were analyzed.

RESULTS

Among 104 patients who underwent liver resection 13(12,5%) had LLR. There were 7 females and 6 males with mean age of 57,5 ± 17 years. LLR was performed for benign lesions in 3 cases and malignant ones in 10 (77%) patients: hepatocarcinoma in 7 patients and synchronous rectal-liver metastasis in 3 patients. Lesions were solitary in 12 (92%) patients with median size of 50mm (15 mm-150 mm). Patients with liver metastasis received combined laparoscopic rectal and liver resection. We used pure laparoscopic approach in 12 (92%) patients and hybrid one in 1 patient. LLR difficulty was category I, II and II in respectively 3(23%), 6(46%) and 4(31%)patients. Conversion rate to open liver resection was 15%. Mean blood loss was 395 min ± 270 min with no hepatic pedicle clamping or peroperative blood transfusion. All resections were tumor free margin. Mortality rate was nil and morbidity occurred in 4(30%) patients: ascites (C-D 2) and pelvic sepsis in combined resections (CD 3b). Median hospital stay was 6 days.

CONCLUSION

Laparoscopic liver resection in our context is safe in selected patients, since no operative mortality, blood transfusion requirement or palliative resection was recorded and liver related morbidity rate was low. Intraoperative ultrasound liver examination capacities are mandatory to improve laparoscopic liver resection program's quality and extend indications.