Complication management after liver surgery and liver transplantation

Brockmann J, Vogel T, Senninger N

Abstract

Surgery of the liver has gained substantial importance throughout recent years. More aggressive surgical treatment options are possible due to the constant improvements in pre-, intra- and postoperative management. This also enabled surgery for macroscopically altered livers as well as for patients with severe co-morbidities. By exact preoperative assessment of the patient and the liver function capacity a small-for-size syndrome (SFS) should be avoided. In case of SFS there are supportive measures available, but only for a limited time period. Due to the particular vascular anatomy of the liver complications arising from the vascular site are of predominant importance. Reduced arterial blood flow is to be treated immediately due to the importance for the biliary system. Major complications arising from the portal venous system are thrombosis and stenosis. These are treated more and more successfully by non-surgical interventions. Impaired hepatic outflow is almost exclusively related to reduced size liver transplantation (e. g. split, live liver donation) and extended right live resections. There is no standard treatment algorithm in case of impaired hepatic outflow. The options range from non-surgical interventions to liver (re)transplantation.