Clinical experience with the intrahepatic posterior approach to the portal triad for right hepatectomy and right segmental resection

An intrahepatic posterior approach to the portal triad has been used over a 2-year period to perform right hepatectomies and right segmental resections in 29 patients (20 men, 9 women; median age 63 years, range 22–82 years). Two resections were palliative for cholangiocarcinomas; the remainder included 9 hepatocellular carcinomas, 12 colorectal metastases, 2 adenomas, 3 cancers of the gallbladder, and one case of chronic hepatic fibrosis. The median operative time was 3 hours 40 minutes (3:40; range 2:20–7:00) with a median period of hepatic ischemia of 87 minutes (range 27–152 minutes). Median blood transfused was 0 unit (range 0–12 units) with only three patients requiring intensive care admission. There was one hospital death. All but one patient was followed up after surgery (median period 24 months; range 1–36 months) at which time there had been three deaths from metastatic disease; the remaining patients were free of clinical recurrence. This operative approach allows minimally resective surgery to be performed safely with excellent shortand medium-term results.