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 short- and medium-term results.