As people become more health conscious, the detection rate of hepatic hemangioma is gradually increasing. As a result, many patients visit hospitals or seek consultation for hepatic hemangiomas found after medical checkups. Among them, many people have a panic psychology about hepatic hemangioma, worrying whether this “tumor” will develop or turn into “cancer” in the future? Do they need surgery or other treatments? Hepatic hemangioma can be easily distinguished from liver cancer, liver cysts and other liver diseases by ultrasound and enhanced CT.
Surgery is usually considered necessary for those with the following indications
1.Hepatic hemangioma with symptoms;
2.Large hemangioma. Usually, surgery can be considered for those with diameter >5cm, while those with diameter below 5cm can be observed;
3.Hepatic hemangioma with “poor” growth location. For example, hemangiomas growing at the edge of the liver or under the left lobe of the fenestra (heart fossa). Hemangiomas in these locations may rupture due to blunt external forces. Actions such as squatting during defecation, squeezing by the steering wheel of a car, or even probing across a table to retrieve something may cause hepatic hemangioma to rupture and hemorrhage.
4.Hepatic hemangioma in young women. The hormonal changes in the body during pregnancy may lead to the increase of hepatic hemangioma, while the intra-abdominal high pressure during pregnancy or delivery may also lead to the rupture of hepatic hemangioma.
5.Heavy physical labor or strenuous sports (such as overhead work, wrestling, soccer, etc.) may lead to trauma to the liver.
6.Hepatic hemangioma with fast growth rate in a short period of time.
For hepatic hemangioma with indications for surgery, open surgery is usually used for treatment. This method requires a long subcostal oblique incision or “L” in the abdomen, which is very traumatic. We successfully performed laparoscopic hepatic hemangioma resection for the patient by making full use of our laparoscopic technique. The results were good and the patient was satisfied.
1.Low bleeding. This is a common feature of laparoscopic surgery. If there is a lot of bleeding, laparoscopy cannot be performed and open surgery may be required instead.
2.Small incision. As with laparoscopic cholecystectomy, two 5-mm and two 10-mm perforations are made in the upper left or upper right abdomen, and one of the 10-mm perforations may be enlarged to 20 mm when the hemangioma specimen is removed at the end of the operation.
3. Postoperative painlessness. Like laparoscopic cholecystectomy, there is no need to give painkillers after surgery.
4.Fast postoperative recovery and short hospital stay. In young and strong patients, they can definitely get out of bed on the second day after surgery. The hospital stay depends on the duration of abdominal drainage, which is usually 3-5 days (< one week. Laparoscopic cholecystectomy is three days postoperative). Compared with open surgery, the advantages are still extremely obvious.
4. No incision infection, fat liquefaction and other concerns. The latter is a condition often seen after open surgery, and often does not heal for a long time, and may also form sinus tracts, requiring re-operation.
5.Aesthetic incision. The same as after laparoscopic cholecystectomy. There is no large scar under the rib cage or in the middle of the upper abdomen. Female patients are generally very satisfied.
Typical cases show
Case1 Hepatic right lobe hemangioma
Preoperative examination.
Intraoperative views.
End-operative pictures.
Postoperative abdominal appearance.
case2 Hemangioma of the left lobe of the liver
Preoperative examination: (missing for the moment, to be added later)
Intraoperative view: (missing, to be added later)
End-operative pictures.
Postoperative abdominal appearance.
Postoperative pathology.