Hemodynamic Effects of Portal Triad Clamping in Man

Delva, E.; Camus, Y.; Paugam, Charles; Hillan, K J; Parc, R; Huguet, Clément; Lienhart, A.

doi:10.1097/00000542-198509001-00105

Cited by 1 publication

(2 citation statements)

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“…Thus, E. Delva et al 4'5 report a substantial diminution of intraoperative blood loss in 90 per cent of cases on account of liver ischemia lasting up to 45-90 min. However, postoperative HI developed in 10 patients, in 6 of them the liver being diffusely altered.…”

Section: Discussionmentioning

confidence: 97%

“…The possibility of maintaining normothermic ischemia of the liver for longer than was formerly conceived, became apparent as a result of accumulated clinical experience which demonstrated that, in distinction from dogs (which actually tolerate ischemia for no longer than 15-20 min), quite important in man are the natural portocaval shunts which prevent blood engorgement of the abdominal viscera. 4 At the same time this advantage is probably considerably restricted during extensive resections of a liver altered by cirrhosis, chronic hepatitis and fibrosis, when the tumoral process is widespread, during liver trauma involving heavy loss of blood, i.e. in states when the amount of retained functional hepatic tissue is relatively small and its lasting ischemia may cause the development of postoperative hepatic insufficiency (HI).…”

Section: Discussionmentioning

confidence: 99%

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A new Simplified Method of Selective Exposure of Hepatic Pedicles for Controlled Hepatectomies

Gal'perin

Карагюлян

1988

HPB Surgery

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Our experience of 90 hepatectomies (HE) and examinations of 64 cadaver livers resulted in the elaboration of a simplified technique for the exposure of hepatic pedicles (HP) and the rapid selective ligation without significant normothermal ischemia of the retained parts of the liver. The method comprises 4 consecutive steps: 1) a superficial T-shaped incision of Glisson's capsule at the site of HP projection on the liver's inferior surface, 2) introduction of the surgeon's forefinger into the liver parenchyma, controlled by clamping the hepatoduodenal ligament, the fingertip finding a tubular structure well distinguished by its smooth elastic surface from the friable parenchyma and bending the finger to hook the pedicle, 3) drawing the hooked pedicle downwards through the slit in the capsule and temporarily clamping it, while releasing the hepatoduodenal ligament so as to restore blood supply to the retained parts of the liver, 4) checking for correct ligature position on the HP before its final ligation by matching the actual ischemic area with the intended line of resection and moving the clamp proximally or distally along the exposed pedicle for the release or clamping of lateral branches as necessary. Whereupon resection can be performed by any of the known methods. This method has been used in 8 major HE, allowing to reduce intraoperative blood loss from 2200±247 ml to 1000±225 ml and reducing general liver ischemia from 10 minutes and more to 2–3 minutes.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%