Advancements in hepatic haemangioma surgery: An update-review of protocols, techniques, and postoperative outcomes

Table 1 Key studies on hepatic haemangiomas: Characteristics, interventions, and surgical outcomes

Ref.	Procedures	Outcomes
Li et al[15]	Hemangioma enucleation: Pringle maneuver applied for portal blood occlusion. Blunt dissection along boundary between hemangioma and normal liver parenchyma. Small vessels and bile ducts transected with ultrasonic knife; large vessels clipped with Hem-o-Lok. Left lateral lobectomy: Incision along falciform ligament; Glisson sheath and left hepatic vein transected with Endo-GIA stapler. Hemostasis with bipolar electrocoagulation, argon spray, or suturing. Specimen retrieval: Removed via specimen bag through trocar; fragmented if needed. Two abdominal drains placed. Intraoperative management: Low central venous pressure (0-4 cm H2O). Intermittent portal occlusion (15 minutes block + 5 minutes release)	Patients: 58 in total (special location group SLG: 27; normal location group NLG: 31). Intraoperative findings: Operation time: SLG 258.4 ± 49.2 minutes vs NLG 186.2 ± 51.8 minutes (P < 0.001). Blood loss: SLG 466.7 ± 235.7 mL vs NLG 259.3 ± 92.6 mL (P < 0.001). Blood transfusion: SLG 29.6% vs NLG 6.5% (P = 0.047). Conversion to laparotomy: SLG 14.8%, NLG 0% (not significant, P = 0.089). No perioperative deaths. Postoperative recovery: Exhaust time: SLG 3.8 ± 1.4 days vs NLG 2.9 ± 0.8 days (P = 0.03). Hospital stay: SLG 11.5 ± 3.4 days vs NLG 7.3 ± 2.6 days (P < 0.01). Postoperative complications: Pleural effusion, ascites, biliary leakage, DVT. Conclusions: Laparoscopic enucleation in special segments is technically challenging with higher intraoperative bleeding risk; safe and feasible with proper planning, skilled team, and readiness to convert to laparotomy; preserves liver parenchyma and achieves effective tumor resection
Xu et al[10]	Total patients: 357. Total hemangiomas: 378. Age (mean): 49.2 ± 10.5 years. Lesion size: 5.0-21.2 cm. Location: 273 subcapsular (laparoscopic ablation), 105 intraparenchymal (CT-guided percutaneous ablation). Procedures: Laparoscopic thermal ablation for subcapsular hemangiomas. CT-guided percutaneous thermal ablation for intraparenchymal hemangiomas. One ablation session for 369 lesions; two sessions for 9 lesions. Technical success rate: 100%	Complete ablation achieved in 361/378 hemangiomas (95.5%). Incomplete ablation in 17 lesions (4.5%). Major complication rate: 2.0% (7/357 patients). Symptom relief in 224 symptomatic patients: 96.4% complete disappearance, 3.6% partial improvement. Ablated lesion shrinkage progressive; 11.4% of hemangiomas almost completely disappeared over time. Median follow-up: 67 months (range 12-124 months)
Zhou et al[4]	Total: 1171 patients, median age 45, 63% women, 53.5% solitary hemangioma, 46.5% multiple. Lesion growth: 38% stable, 60% slow (< 1 cm/year), 2% rapid (≥ 1 cm/year). Score based on symptoms, size, location, growth rate (0-2 each): Score ≥ 4 → surgery recommended, score < 4 → observation; alternatives: TAE or RFA	Score ≥ 4: Surgery → 97% symptom-free, 9% complications, 1.8% needed intervention, observation → 44% symptom-free, 40% required intervention. Score < 4: Surgery → 94% symptom-free, 12% complications, observation → 88% symptom-free, 4% required intervention

SLG: Specia location group; NLG: Normal location group; DVT: Deep vein thrombosis; CT: Computer tomography; TAE: Transarterial embolisation; RFA: Radiofrequency ablation.