Morbidity and Mortality After Liver Surgery

• The historical high morbidity and mortality rates associated with liver resections has decreased significantly over time. The pattern of complications has also changed.Massive intraoperative blood loss has become very rare, but other complications such as bile leak remain high.

• Modern methods to prevent blood loss, especially allogeneic blood transfusion,include the use of intraoperative low central venous pressure, various methods of vascular clamping, intraoperative blood salvage, preoperative autologous donation,acute intraoperative normovolemic hemodilution, and efficient modalities of parenchymal transection.

• Postoperative liver failure is one of the most serious complications after a hepatectomy. Although uncommon, it is associated with high mortality. Knowledge of risk factors is crucial because prevention is the best approach to avoid mortality. However, early identification of liver failure allows for some effective measures.

• Bile leak is the most common biliary complication after liver resections. Most resolve with conservative approaches, and the need for surgical approach is associated with higher mortality rates. Proper intraoperative detection and closure of bile leaks is essential to prevent postoperative biliary fistula.