Intermittent Pringle Maneuver and Hepatic Function: Perioperative Monitoring by Noninvasive ICG‐Clearance

Abstract

Background Intermittent Pringle maneuver or selective portal clamping often are used to control inflow during parenchymal liver transection. This study was designed to determinate whether these maneuvers are associated with adverse hepatic function. Methods Resection was performed without portal clamping in 17 patients (group 1). Selective continuous portal clamping was performed in 11 patients (group 2) and the remaining 33 patients (group 3) had intermittent nonselective portal clamping (occlusion of the main portal trunk). The centers' protocol for total portal occlusion is 15-min occlusion alternated with 5-min reperfusion in patients with normal liver parenchyma or 10 min alternated with 5 min in patients with abnormal parenchyma. ICG elimination tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate (PDR-ICG-%/min) and 15-min retention rate after administration (ICG-R15-%). Results There was no statistically difference between the three studied groups in terms of sequential changes of ICG-PDR (p \ 0.625) or ICG-R15 (p \ 0.398).Conclusions Our study indicates that 15 min of intermittent Pringle maneuver or selective hemihepatic continuous portal clamping are safe methods of vascular control during liver resection, with no adverse effects on hepatocellular function.

Mitochondrial bioenergetics and posthepatectomy liver dysfunction

“…We also found an association of HPC with mitochondrial dysfunction. Our strategy of intermittent HPC in an on-need basis is usually considered safe [19,20], but mitochondrial membrane depolarization was significantly worsened in patients with over 20 min of HPC, whereas it was improved in patients with under 20 min, possibly reflecting a mechanism of ischaemic preconditioning [34]. Curiously, HPC time over 20 min has previously been associated with an increased risk of liver failure and mortality [35].…”

Functional hepatocellular regeneration in elderly patients undergoing hepatectomy

“…In addition, gender, history of neoadjuvant therapy, indication for hepatectomy, extent of hepatectomy and clamping of the portal triad did not affect the liver regeneration capacity, in both groups. In fact, several authors defend the safety and utility of portal triad clamping in bleeding control during the hepatectomy, without harming hepatocellular function . Lastly, it has been demonstrated that Pringle maneuver performed during liver resection reduces blood loss, which contributes to preserved postoperative liver function .…”

Unfeasible experimental model of normothermic hepatic ischemia and reperfusion in rats using the Pringle maneuver

“…Tralhão et al 28 , in Coimbra, used two tactical options to help assist the performance of elective liver resections in 61 patients. The intermittent Pringle maneuver was performed in 33 patients and selective clamping of the right or left branches of portal vein and the hepatic artery was used in 11 patients.…”

“…of vascular occlusion interspersed with the same 5 min. reperfusion when the liver function is compromised 28 .…”