The first planned liver resection in Serbia

Abstract

Perioperative bleeding, difficulties to establish a safe hemostasis, postoperative infections, biliary fistulas, and other possible complications were the reasons why operations on the liver were introduced more slowly and later then the ones on most other organs. A 26-year-old woman, who three years previously developed a moderate pain in the upper abdomen, where she initially noticed a small mass, which continued to rise gradually, followed by the increase in pain severity. She retained good appetite the entire time, had no loss in body mass, and did not vomit. On examination, a mass of the rough surface, the size of a “male fist,” moderately sensitive on palpation, respiratory movable, hard on palpation, was found in the epigastrium and below the left costal margin. At an operation performed by V. Subbotić on July 4, 1922, under general anesthesia, a tumour the size of “two male fists,” arising from the left lobe of the liver, covered by great omentum, was successfully resected. The postoperative recovery was uneventful. Three months after surgery, at the time of presentation, the patient was in good health, with no signs of recurrence. Histology showed primary carcinoma of the liver. The presented case was the first successful liver resection performed in a period when such operations were rare in Europe. The article speaks in favor of high level of surgery carried out by Dr. Vojislav Subbotić, the founder of modern surgery in Serbia, as well as the first professor of surgery of a newly founded Medical Faculty in Belgrade, of whom Serbian surgeons can be proud of. That is why his early death, which took place in a period when he was establishing a modern university surgical clinic, was a tremendous loss.

Keywords

• liver
• carcinoma
• successful resection
• Vojislav Subotic