Anesthésie pour chirurgie hépatique

Two types of hepatic surgery should be differentiated, according to the existence of underlying liver disease and its subsequent ability to regenerate hepatic surgery with normal non tumoral parenchyma: it is the most common case. This indication concerns at first metastatic disease (usually colorectal cancer), but also benign diseases with increased hemorrhagic risk (angioma, adenoma, traumatism; or rarely tumours [carcinoids, etc. ]). Enlarged resections up to 70 % of liver volume are feasible. Vascular clamping, allowing surgeons to perform a perfect surgical act in a bloodless operating field, can exceed 60 minutes; hepatic surgery with underlying liver disease: most frequently hepatocellular carcinomas (cirrhosis), but also cholangiocarcinomas (cholestasis). The risk of hepatic failure is increased when compared to a resection of a normal liver, due to an impaired regeneration potential. Clamping time should be shorter (less than 45 minutes), and resection volume should be limited, as the risk of increased postoperative morbimortality is unacceptable. Preoperative tomodensitometric reconstruction and hepatic functional tests are of great interest in order to prevent the postoperative risk of hepatic failure. Liver volume preservation by preoperative portal branch occlusion may be an interesting choice in selected cases. The main intraoperative risks are bleeding and, less commonly, gas embolism. Their occurrence can be limited by vessels clamping, requiring a good knowledge of the different types of clamping techniques and their hemodynamic consequences. The postoperative period involves invaluable specific care that aims to prevent hepatic failure and promote liver regeneration.