Laparoscopic right hemihepatectomy for polyadenomatosis
Epublication WebSurg.com, Jun 2012;12(06). URL: http://websurg.com/doi/vd01en3722
Hepatic adenomatosis was first described in 1985 by Flejou et al. as multiple adenomas (arbitrarily more than 10), in an otherwise normal liver parenchyma. Several authors have suggested that it is a distinct entity from hepatic adenoma, which is predominantly seen in young women taking oral contraceptives. Although considered a benign disease, it can be associated with potentially fatal complications such as malignant transformation and intraperitoneal hemorrhage due to rupture. Currently, there is no consensus on patient management. However, surgical removal of large lesions may significantly improve symptoms and reduce the risk of complications. Genetic counselling may now play an important role in case management. We report the case of a 33-year-old woman who underwent a laparoscopic right liver resection for multiple liver adenomatosis. This patient had already had a right liver-appended adenoma resected as well as a cholecystectomy. Five trocars are placed in a semilunar fashion approximately one handbreadth apart along a line one handbreadth below the right subcostal margin. Hepatic inflow is taken extraparenchymally before the transection of the hepatic parenchyma in an anterior to posterior fashion.