Comparison of controlled and Glisson’s pedicle transections of hepatic hilum occlusion for hepatic resection11No competing interests declared.

Hanging manoeuver for a left hepatectomy using Glisson's approach with a focus on tape position in liver hilum

“…An extended left hepatectomy has been reported to increase the risk of central bile duct injury such as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct, right or left hepatic duct . Bile leakage was more common in the Glisson's pedicle transection method group than in standard controlled method group, and occurred more frequently in patients who underwent a left hepatectomy than in those who underwent a right hepatectomy . In this study of the so‐called disadvantageous left liver resection in terms of biliary complication that also included 55 extended left hepatectomies and 2 left trisectionectomies using the Glisson's pedicle transection method, the biliary complications occurred in 5 patients (3.3%) and all of them were biliary leakage with no stricture.…”

Alternative management of anatomical right hemihepatectomy using ligation of inflow and outflow vessels without hilus dissection

“…The increasing incidence of hepatic tumors has resulted in a greater number of hepatic resections and consequent advances in hepatectomy techniques. In a comparison of controlled and Glisson's pedicle transection of the hepatic hilum occlusion for liver resection, no differences were found in intraoperative variables and postoperative complications between the two techniques except for bile leakage, which was more frequent with dissection of Glisson's pedicle 8 . The Pringle maneuver and various techniques of hemihepatic clamping have also been compared.…”

“…Although the Pringle maneuver or total vascular exclusion are commonly used during liver resection, ischemic damage is still a major problem, particularly in patients with chronic hepatitis or cirrhosis 14–16 . Therefore, ligation of the inflow and outflow vessels of the lesion‐located lobe of the liver using the Glissonean approach is often used to reduce intraoperative blood loss during transection of the parenchyma, as well as to prevent ischemic damage, avoid intraoperative spread of tumor cells during hepatectomy and reduce the risk of postoperative liver failure 6–10 . Nevertheless, even though the Glissonean approach has a number of advantages when compared with the Pringle maneuver, bile leakage remains a problem.…”

“…Intraoperative blood loss and the risk of postoperative liver failure can be reduced by dividing the appropriate vascular inflow of the liver before parenchyma transection to achieve hemihepatic devascularization. The Glissonian approach is often employed to accomplish this and involves primary dissecting of the entire Glisson's sheath of the pedicle directly after division of a substantial amount of the hepatic tissue in order to reach the pedicle 6–10 . In 1986, Takasaki et al 11 .…”

“…introduced a highly selective hepatic resection using the Glissonean sheath binding method and in 1990 introduced a refinement of this approach with Glissonean sheath code transection at the hepatic hilus 12 . However, several more recent reports have indicated that the Glissonian approach is tedious, time consuming and may lead to bile leakage in the postoperative period 8,13 …”