Infrahepatic inferior vena cava clamping in hepatectomy for tumors involving hepatocaval confluence

Yang, Jiamei; Sui, Chengjun; Kan, Tong; Li, Bin; Zhou, Yanming

doi:10.1016/j.asjsur.2013.01.002

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…In addition, infrahepatic IVC clamping may considerably reduce the adverse effects of reduction of CVP by anesthesiological interventions and the risk of intraoperative bleeding primarily from the hepatic veins [ 27 , 28 ]. In this study, using IVC clamping to control blood loss, we were in a position to precisely identify the major vascular architecture around the hemangioma and selectively clip or ligate it, thus limiting blood loss during liver transection [ 14 ]. With fewer blood vessels traversing the capsule, the tumor can be enucleated without much blood loss by cutting open this layer between the capsule of the hemangioma and the liver.…”

Section: Discussionmentioning

confidence: 99%

Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas

Zhang

Wang

et al. 2017

Surg Endosc

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BackgroundThis study aimed to determine the feasibility of the extracapsular enucleation method for giant liver hemangiomas by infrahepatic inferior vena cava (IVC) clamping and the Pringle maneuver to control intraoperative bleeding under laparoscopic hepatectomy.MethodsFrom January 2012 to January 2016, 36 patients underwent laparoscopic extracapsular enucleation of giant liver hemangiomas. Patients were divided into two groups: infrahepatic IVC clamping + Pringle maneuvers group (IVCP group, n = 15) and the Pringle maneuvers group (Pringle group, n = 21). Operative parameters, postoperative laboratory tests, and morbidity and mortality were analyzed.ResultsThe mean size of liver hemangiomas was 13.3 cm (range 10–25 cm). Infrahepatic IVC clamping + the Pringle maneuvers with laparoscopic extracapsular enucleation significantly reduced intraoperative blood loss (586.7 vs 315.3 mL, p < 0.001) and transfusion rates (23.8 vs 6.7%, p = 0.001), compared with the Pringle maneuver alone. The gallbladder was retained in both groups. The mean arterial pressure (MAP) in Pringle group remained virtually stable before and after clamping of hepatic portal, while it was significantly decreased after IVC clamping in IVCP group than that pre-clamping (p < 0.001). The heart rate of all patients was significantly increased after clamping when compared to pre-clamping heart rates (p < 0.001). Once vascular occlusion was released, MAP returned to normal levels within a few minutes. There were no significant differences in postoperative complications between two groups. The vascular occlusion techniques in both groups had no serious effect on postoperative of hepatic and renal function.ConclusionsExtracapsular enucleation with infrahepatic IVC clamping + the Pringle maneuver is a safe and effective surgical treatment to control bleeding for giant liver hemangiomas in laparoscopic hepatectomy.

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Section: Discussionmentioning

confidence: 99%

Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas

Zhang

Wang

et al. 2017

Surg Endosc

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“…The PM time ranged from 10 to 20 minutes with 5 min break, across studies. In the five studies reporting average PM duration, it ranged from 12.6–58.3 minutes in the IIVCC+PM group and 13.5–65.6 minutes in the PM alone group [ 11 – 13 , 18 , 20 ]. Only four studies reported the average IIVCC duration with it ranging from 5.5–66.5 minutes [ 12 , 13 , 18 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Rahbari et al have shown that IIVCC may be more effective, in comparison to anaesthesiological interventions alone, in reducing intraoperative bleeding while minimizing the risk of hemodynamic instability [ 6 ]. Several studies have also assessed the feasibility of IIVCC combined with PM in reducing parenchymal bleeding during hepatic transection [ 10 – 13 ]. Conversely, some studies have also emphasized that IIVCC may also result in significant intraoperative hypotension and increase the risk of pulmonary embolism [ 6 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative outcomes of utilizing infrahepatic inferior vena cava clamping and Pringle maneuver during hepatectomy: a meta-analysis

Patel,

Tan,

Lambert

et al. 2024

Langenbecks Arch Surg

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Purpose Intraoperative bleeding during hepatectomy is primarily controlled through anaesthesiological interventions or surgical techniques such as Pringle maneuver (PM). Infrahepatic IVC clamping (IIVCC) is an alternative surgical technique to reduce central venous pressure and prevent retrograde hepatic venous bleeding. The aim of the meta-analysis was to compare IIVCC+PM with PM alone in terms of intraoperative outcomes and perioperative complications. Methods Medline, Cochrane Library, Scopus, Web of Science, and EMBASE were searched for comparative studies till 16.04.2024, resulting in 679 articles, of which eight studies met inclusion criteria. Data on patient demographics, surgical technique, and perioperative outcomes was assessed. Cochrane Risk of Bias 2.0 (RoB 2.0) Tool and Newcastle-Ottawa Scale (NOS) were used for risk of bias assessment. Results Two randomized controlled trials, one prospective, and five retrospective cohort studies with 358 patients in IIVCC+PM and 397 patients in PM alone group were included. IIVCC+PM resulted in significantly greater CVP reduction, less intraoperative blood loss (MD (95% CI) = − 233.03 (− 360.48 to − 105.58), P < 0.001), and less intraoperative blood transfusion (OR (95% CI) = 0.38 (0.25 to 0.57), P < 0.001) compared to PM alone. The two groups had comparable total operative time, transection time and total intraoperative fluid infusion. Patients undergoing IIVCC+PM had significantly shorter length of stay (MD (95% CI) = − 0.63 days (− 1.21 to − 0.05 days), P = 0.03) and overall complication rates (OR (95% CI) = 0.63 (0.43–0.92), P = 0.02) compared to PM alone group. Conclusion The utilization of IIVCC along with PM during liver resection may be beneficial in reducing intraoperative bleeding and blood transfusion without adversely influencing operative times or perioperative outcomes compared to PM alone.

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“…There are 601 cases in the treatment group and 651 cases in the control group. Six of them [ 13 , 14 , 16 , 18 , 20 , 23 ] compared IVCC with control, five of them [ 15 , 17 , 19 , 24 , 25 ] compared IAC with control, and two of them [ 21 , 22 ] compared IVCC with IAC. Figure 1 shows the flow chart from literature search result to final trial inclusion.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness and Safety of Controlled Venous Pressure in Liver Surgery: A Systematic Review and Network Meta-Analysis

Zhang

Wang

et al. 2015

BioMed Research International

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Objective. To investigate the effectiveness and safety of controlled venous pressure in liver surgery and further to compare the clinical outcomes of low central venous pressure by infrahepatic inferior vena cava clamping (IVCC) and intraoperative anesthetic control (IAC). Methods. Online databases including PubMed, Embase, Cochrane Library, Clinical trials.gov, and China biology medicine database were comprehensively searched. After identifying relevant studies out of the search results, quality assessment was performed according to the methods recommended by the Cochrane collaboration. And meta-analysis was performed by both direct comparison and indirect comparison. Results. Thirteen studies containing 1252 patients were included. Compared with control, controlled venous pressure significantly decreased central venous pressure, total blood loss, blood loss during transection, transfusion rate, and total incidence of complications. Further analysis of IVCC and IAC showed that there was no significant difference in aspects of main clinical outcomes. Conclusions. Controlled venous pressure significantly decreased central venous pressure and achieved improvement of bleeding control in liver surgery. It reduced total incidence of complications and chest infection, while it caused concerns about heart disorder. Although IVCC was not worse than IAC in therapeutic effect, a superiority between them still needs to be explored.

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Infrahepatic inferior vena cava clamping in hepatectomy for tumors involving hepatocaval confluence

Abstract: Infrahepatic IVC clamping is generally effective and safe in controlling bleeding during hepatectomy for tumors involving hepatocaval confluence.

Cited by 6 publications

References 16 publications

Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas

Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas

Perioperative outcomes of utilizing infrahepatic inferior vena cava clamping and Pringle maneuver during hepatectomy: a meta-analysis

Effectiveness and Safety of Controlled Venous Pressure in Liver Surgery: A Systematic Review and Network Meta-Analysis

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