Major and minor segmentectomies “réglées” in liver surgery

Abstract

Abstract Individualization of the segment as the functional anatomical unit of the liver permits the performance of surgical segmentectomies. These segmental resections are “réglées” because the plane of cleavage of the hepatic parenchyma follows the anatomical scissurae. From the technical point of view, liver segmentectomies are characterized by an exclusive transparenchymatous approach to the vascular pedicles of the segment to be removed. We have performed this type of surgery in 22 patients with no mortality. These operations are indicated in: (1) some benign tumors; (2) some liver trauma; (3) biliary operations above the hilus, where anterior resection of segment IV can be necessary; and (4) carcinomas of the gallbladder discovered histologically after cholecystectomy. Liver segmentectomies can also be indicated for malignant tumors when the liver is cirrhotic, or when an extended resection is likely to expose the patient to the risk of liver failure. Indeed, one of the main advantages of liver segmentectomies is that they permit an economical but safe surgical resection of the hepatic parenchyma.