PREVENTION OF PLEURAL EFFUSION AFTER HEPATECTOMY USING FIBRIN SEALANT

Retention of pleural effusion after hepatectomy is an important compli cation that may affect the postoperative course. However, there are fe w reports on its pathogenesis or preventive measures. We evaluated the mechanism of the development of this complication and preventive meas ures against it. During the past 4-year period, hepatectomy was perfor med in 77 patients, of whom 64 underwent liver mobilization by transec ting the hepatic ligaments. A fibrin sealant was sprayed on the cut su rface of the hepatic ligaments in randomly selected 25 of the 64 patie nts to determine whether this application can prevent postoperative re tention of pleural effusion. Post-operative pleural effusion was not o bserved in any patient treated by fibrin sealant spraying but was obse rved in 13 (30%) of the other 39 patients treated with this sealant (p < 0.05). In addition, none of the 23 patients in whom the liver was n ot mobilized during hepatectomy showed postoperative pleural effusion. These results suggest that severance of the hepatic ligaments is a ma jor cause of pleural effusion, and application of a fibrin sealant to the undersurface of the diaphragm around the insertion of the liver li gaments is useful for preventing this complication.