Location of Hemangioma is an Individual Risk Factor for Massive Bleeding in Laparoscopic Hepatectomy

BACKGROUND AND OBJECTIVES:The scope of laparoscopic surgery has expanded to encompass hepatic resections, specifically hepatic hemangioma. The most serious intraoperative complication is bleeding, often requiring laparotomy. Because risk factors associated with such massive blood loss have not been well evaluated, the intent of this retrospective study was to analyze these risk factors associated with laparoscopic resection of hepatic hemangiomas.METHODS:From June 1, 2011 to January 31, 2021, 140 consecutive patients underwent laparoscopic surgery for hepatic hemangioma in our hospital. According to quantity of intraoperative blood loss, they were divided into massive (≥ 800 ml) and minor blood loss (< 800 ml) groups. Perioperative data were analyzed by univariate and multivariate analyses with logistic regression to identify the risk factors for potential massive blood loss during laparoscopic resection.RESULTS:There were 24 and 116 patients in the massive and minor blood loss groups, respectively. Of four risk factors significantly associated with massive blood loss by univariate logistic regression analysis (location of hemangioma in the liver, postcaval or hepatic venous compression, hilar compression, and body mass index exceeding 28) the multifactorial logistic model identified only location in the liver of the hemangioma as statistically (P = 0.012) associated with intraoperative massive blood loss.CONCLUSIONS:Location of the hepatic hemangioma was the single statistically significant risk factor for massive blood loss during laparoscopic surgery for hepatic hemangioma. Of particular importance, location in Couinaud liver segments I, IVa, VII, and VIII necessitates precautions to mitigate the risk of massive blood loss.