Surgical approach for symptomatic giant liver hemangiomas

Purpose: Although diagnosis of liver hemangiomas are increased by the development of new imaging methods, controversy is still emerged in the management. Surgery is the most preferred approach in symptomatic cases. In this prospective study, we aimed to investigate 49 cases who were operated for hepatic hemangiomas in the General Surgery Department of Çukurova University Medical Faculty between 1999-2009 and to compare our results with current literature.Matherial and Methods: The followings were recorded from the archives: Demographic findings, age, gender, complaints of patients, laboratory findings, localization of the hemangiomas, surgery indication, diameter of the tumor, surgical procedure, blood transfusion, postoperative hospital stay, complications, pathologic findings and mortality rates.Results: 39 (79.6%) of the patients were female and 10 (20.4%) of were male; median age was 46.2±8.54. Abdominal pain was the most frequent complaint (75.5%). Five cases (10.2%) showed pressure symptoms and seven cases had suspicion of malignancy (14.3%). Hemangiomas of 25 (51%) cases located in right lobe, 18 (36.7%) located in left lobe and 6 (12.2%) located in both lobes.The diameter of hemangioma were ? 5 cm in 47 (96%) and < 5 cm in 2 (4%) of the patients. As surgical procedure; enucleation was performed in 28 (57.1%) and anatomic liver resection was performed in 21 (42.9%) patients.The median operation time was found to be statistically significantly lower in enucleation group when compared to resection group (p<0.05). Transfusion requirement was lower in enucleation gruop but the difference did not attain statistical significance (p>0.05). Hospital stay was statistically lower in enucleation group (p<0.05).Complication was seen in 8 (38.1%) cases of resection group. There was no complication in enuclation group (p<0.05). Atelectasia and pleural effusion were the most frequent complications that seen in 5 (10.5%) of patients. Collection, pneumonia and pulmonary embolism was seen in three cases as other complications.In totally 49 cases, the mortality rate was 6%. Pulmonary embolism, liver failure and myocardial infarction were the reasons of mortality.Cavernous formation was seen in 47 (96%) and capillary formation was seen in 2 (4%) of the patients in pathologic investigation.Conclusion: We agree that liver hemangiomas must be distinguisted. If the liver hemangiomas is asymptomatic, we can follow these patients 3 or 6 months periods.Key words: Liver hemangioma, enucleation, resection, blood tranfussion, complication