Repeated Laparoscopic Hepatectomy for Hepatocellular Carcinoma Developed following Tuberculous Peritonitis—Report of a Case—

Abstract

A 60-year-old man who had been followed for chronic hepatitis C was admitted to our hospital for hepatocellular carcinoma (HCC). An abdominal contrast-enhanced CT scan showed a tumor, 10 mm in diameter, in the S4 segment of the liver. Intraabdominal severe adhesion was expected from his history of tuberculous peritonitis. However, total laparoscopic partial hepatectomy was performed because the tumor was solitarily located at the surface of the liver at the segment S4. Although adhesions from the liver to the abdominal wall were showed, laparoscopic hepatectomy could be performed by minimum division of adhesions. The postoperative course was uneventful, and he was discharged 7 days after the operation. Eight months later, a new 12-mm HCC occurred in the S7 segment and laparoscopic partial hepatectomy (S7) was performed because the tumor was located at the liver surface as before and away from the former surgical site. The postoperative course was uneventful, and he was discharged 9 days after the second operation. The patient is now doing well and cancer-free at 1 year 9 months after the initial surgery. Laparoscopic hepatectomy may be difficult to perform in this case because adhesions caused by tuberculous peritonitis might restrict vision and manipulation of forceps. We could safely perform laparoscopic hepatectomy twice for recurrent as well as primary HCC with adhesions due to tuberculous peritonitis.