Laparoscopic treatment of liver hemangioma

Cavernous hemangioma is the most common benign liver tumor. Lesions greater than 4 cm have been called giant hemangiomas and may present as a symptomatic abdominal mass. Although most giant hemangiomas are asymptomatic and can be managed conservatively, in a small number of patients, these tumors, irrespective of their size, may be responsible for abdominal pain, nausea, early satiety, and even thrombocytopenia, thus requiring a surgical approach. Surgical options to treat symptomatic liver hemangiomas are enucleation, liver resection, and, in the rare event of large or multiple hemangiomas causing liver failure, liver transplantation. When cavernous hemangioma becomes symptomatic, enucleation is considered the treatment of choice because of its lower morbidity compared with liver resection. Therefore, although there have been many series of laparoscopic liver resection, only a few cases of laparoscopic enucleation of liver hemangiomas have been reported. Here we report the case of a 36-year-old woman with a symptomatic 4-cm liver hemangioma of the left lobe who underwent laparoscopic enucleation, with complete relief of the symptoms at the 3-month follow-up. The operating time was 90 minutes. Neither liver mobilization nor ligament division was necessary. The dissection was carried out with minimal blood loss. The postoperative period was uneventful, and the patient was discharged on postoperative day 4. Laparoscopic enucleation is easy to perform in suitable lesions, and its advantage with respect to liver resection is the preservation of healthy parenchyma and liver ligaments. No outflow occlusion is needed, and the intraoperative bleeding is easily controlled. Technical aspects of laparoscopic enucleation are described and a review of the literature is also provided.