J.Jpn. Surg. Soc.. 87(9): 1197-1200, 1986
Report on the annual meeting
POSTOPERATIVE COMPLICATIONS OF Appleby’s OPERATION DUE TO ISCHEMIA AND MEASURES FOR THEIR PREVENTION
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Second Department of Surgery, University of Tokyo, Tokyo, Japan Ichiro Iizuka, Toshiro Konishi |
Results：
(1) Necrosis of the liver, necrosis of the gallbladder and dehiscence involving the duodenum occurred in 5%, 8% and 7% of the patients respectively, whereas they never ocurred among 41 cases of conventional total gastrectomy.
(2) Eight out of 10 patients who postoperatively showed GOT values higher than 500 KU suffered from either of these three complications.
(3) In 8 out of 14 patients who had these complications, either abnormal findings that suggested inadequacy of collateral arteries, or hepatic abnormalities such as cirrhosis and metastasis, were observed.
The results strongly suggest that these complications were closely related to the ischemia following division of the common hepatic artery.
To reduce these complications, the following policy during the operation is recommended.
(A) To abandon Appleby’s operation when pulsation of the proper hepatic artery becomes very weak after tentative occlusion of the common hepatic artery or there is any other sign of inadequacy of collaterals, and when the Iiver is cirrhotic or bears metastases.
(B) To add cholecystectomy if there is any doubt as to the adequacy of collateral arteries when Appleby’s procedure is aiready performed.
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