**6. Postoperative complications**

The main postoperative complications include postoperative hemorrhage, liver dysfunction, biliary leak and fluid collections. Postoperative hemorrhage is uncommon after liver resection if meticulous attention is given to confirmation of hemostasis at the conclusion of the case. Bleeding may occasionally occur from retroperitoneal structures, such as the adrenal gland, or diaphragmatic musculature. Argon beam coagulator and a variety of topical hemostatic applications are utilized to reduce liver surface related bleeding.

Post hepatectomy liver failure (PHLF) is a major postoperative complication with mortality of approximately 30%. The definition of post-hepatectomy liver is the impaired ability of the liver to maintain its synthetic, excretory and detoxifying functions, characterized by an increase in international normalized ratio and bilirubin on or after postoperative day 5 [44]. The most effective treatment of PHLF is liver transplantation but that is reserved for the most severe cases. Initial care is supportive and often includes mechanical ventilation, hemodynamic support and hemodialysis. Administration of colloid products and nutritional supplementation is also advocated.

The best way to treat post-hepatectomy liver failure is to prevent it. Preoperative weight loss, nutritional supplementation, careful preoperative selection and risk stratification are important to minimize the risk of PHLF [10]. Intra-operatively, minimizing blood loss and blood transfusion, close attention to hemostasis and minimizing skeletonization of the hepatoduodenal ligament will lower risk of PHLF. In the postoperative period, recognizing and aggressively treating postoperative hemorrhage, biliary obstructions or leaks and intra-abdominal infections will reduce the hepatic stress and likelihood of developing hepatic failure.

Postoperative fluid collections collect in the resected liver bed. These collections are varied in etiology but can include hematoma, seroma or biloma. They often to not result in symptoms, but occasionally they can cause pain or fullness requiring drainage. These collections also are at risk for infection and abscess formation. Biliary leakage from the raw surface of the resected liver can occur in up to 8% of patients after liver resection [45].
