Portal Triad Clamping or Hepatic Vascular Exclusion for Major Liver Resection

Belghiti, Jacques; Noun, Roger; Zante, Evelyne; Ballet, T; Sauvanet, Alain

doi:10.1097/00000658-199608000-00007

Cited by 325 publications

(264 citation statements)

References 13 publications

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“…Strategies to prevent blood loss during liver resection include vascular occlusion either by inflow control (Pringle manoeuvre) or by inflow and outflow control (total vascular exclusion) 2,3 . The major drawback of these methods is the ischaemia-reperfusion damage to the liver parenchyma.…”

Section: Introductionmentioning

confidence: 99%

Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Muratore

Ribero

Ferrero

et al. 2003

British Journal of Surgery

114

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Background:The major drawback of hepatic pedicle clamping is ischaemia-reperfusion injury with impairment of liver function. Perioperative steroid administration has been advocated to reduce liver damage. The aim of this prospective, randomized study was to determine whether steroid administration can reduce liver injury and improve short-term outcome.Methods: Fifty-three patients undergoing liver resection were randomized to a steroid group (group 1) or to a control group (group 2); patients in group 1 received methylprednisolone 30 mg/kg 30 min before liver resection whereas those in group 2 did not. Serum levels of interleukin (IL) 6, total bilirubin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and prothrombin time (PT) were measured. Length of stay, and type and number of complications were recorded.Results: Serum IL-6 levels were significantly lower in the steroid group than in the control group 24 h after surgery. Steroid administration significantly modified AST, ALT and PT levels only in patients with chronic liver disease. Overall and lung-related morbidity were not significantly different between the two groups.Conclusions: Steroid administration suppresses serum IL-6 levels, but has no effect on shortterm outcome.

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Section: Introductionmentioning

confidence: 99%

Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Muratore

Ribero

Ferrero

et al. 2003

British Journal of Surgery

114

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“…This maneuver, which is associated with only minimal hemodynamic consequences, is commonly used during liver surgery to minimize blood loss. [1][2][3][4] One important concern, however, is that the Pringle maneuver may cause parenchymal ischemic injury in association with extended periods of clamping. For that reason, intermittent inflow occlusion (IIO) followed by short periods of reperfusion has been introduced into clinical practice and is being used increasingly.…”

Section: Introductionmentioning

confidence: 99%

Intermittent inflow occlusion in living liver donors: Impact on safety and remnant function

et al. 2004

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Clamping of the portal triad accomplishes complete inflow occlusion. This maneuver is commonly used during liver surgery to minimize blood loss but is not widely used in living donors undergoing resection for liver transplantation. We compared outcomes in living donors who underwent resection with and without inflow occlusion. We reviewed data on 2 nonsimultaneous living liver donor cohorts. The first 20 donors (group 1) underwent resection without inflow occlusion. In the next 15 donors (group 2), inflow occlusion was used during parenchymal transection, using cycles of 10 -15 minutes occlusion and 6 minutes reperfusion. In donors, we recorded type of resection; ischemia times; blood loss; transfusions; peak ALT, AST, bilirubin, and INR in the first 5 days; hospital length of stay (LOS), and major complications. In recipients, we recorded peak ALT. In group 1, 19 of 20 donors underwent right hepatectomy. In group 2, 8 donors underwent right hepatectomy, and 7 donors had left lobectomies. Total ischemic time ranged from 16 -49 minutes (mean, 31 ؎ 9 minutes). In group 1, two donors received a total of 5 U of allogeneic blood. In group 2, no donor required transfusion. Mean peak ALT was significantly higher in group 1 (521 ؎ 336 U/L) than group 2 (322 ؎ 162 U/L; P ‫؍‬ 0.03). Mean INR was significantly higher in group 1 (1.8 ؎ 0.2) vs. group 2 (1.5 ؎ 0.2; P ‫؍‬ 0.001). There were 4 major complications in group 1 (incisional hernia, transient liver failure, biliary stricture, and biliary leak) and no major intraoperative or postoperative complications in group 2. Mean LOS was significantly longer in group 1 (7.9 ؎ 2.9 days) than group 2 (6.2 ؎ 1.1 days; P ‫؍‬ 0.04). Mean peak ALT in recipients trended lower in group 2. In conclusion, inflow occlusion was associated with reduced blood loss and less ischemic injury to hepatic remnants in the donors and the grafts in the recipients. These benefits were associated with a diminished incidence of major complications and shorter LOS. Inflow occlusion should be an essential part of living donor hepatectomy. (Liver Transpl 2004;10:244 -247.)

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“…A grande área cruenta resultante da ressecção central pode ocasionar importante sangramento intra-operatório e, além disto, resultar em fístulas biliares pós-operatórias. A evolução nos procedimentos de controle do aporte sanguí-neo como o clampeamento intermitente do pedículo hepáti-co 18,19 , a exclusão vascular total [20][21][22] e, mais recentemente, a abordagem segmentar através do acesso intra-hepático aos pedículos glissonianos [23][24][25] , melhorou sobremaneira o sangramento intra-operatório diminuindo a necessidade de hemotransfusões.…”

Section: Doençaunclassified

Meso-hepatectomia: uma alternativa para a ressecção hepática alargada

Herman¹,

Machado²

2005

Rev. Col. Bras. Cir.

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RESUMO: Objetivo: Discutir as indicações e resultados da meso-hepatectomia (hepatectomia central), um procedimento raro, trabalhoso e desafiador. Método: Estudo de três pacientes portadores de hepatopatia e diagnóstico de tumor de localização central no parênquima hepático, submetidos à meso-hepatectomia. Para realização do procedimento, empregou-se a abordagem glissoniana aos pedículos dos segmentos a serem ressecados, sem clampeamento do hilo hepático. Resultados: Apenas um paciente necessitou de transfusão de glóbulos durante a operação. O tempo médio da operação foi de quatro horas. Não se observaram complicações pós-operatórias e o tempo médio de internação foi de seis dias. Conclusões: A meso-hepatectomia é um procedimento que apesar de trabalhoso pode ser padronizado e realizado com segurança em pacientes com tumores centrais e hepatopatia associada. A preservação do parênquima, tem papel importante na boa evolução dos pacientes e, o acesso glissoniano, é um procedimento útil, tanto do ponto de vista técnico como para evitar a isquemia do parênquima remanescente (Rev. Col. Bras. Cir. 2005; 32(2): 90-93 INTRODUÇÃODefine-se como hepatectomia central ou mesohepatectomia a ressecção dos segmentos centrais do fígado, IV, V e VIII preservando-se os segmentos laterais esquerdo e direito do fígado 1 . Este tipo de ressecção é muito raramente empregado, tecnicamente muito difícil, no entanto, tem suas indicações 2-4 . O tratamento de tumores localizados centralmente no fígado geralmente é realizado através da ressecção anatômica regrada, como as hepatectomias esquerda ou direita ampliadas, entretanto, em situações em que é necessária a preservação do parênquima (hepatopatias por exemplo), as ressecções ampliadas podem ocasionar insuficiência hepáti-ca pós-operatória. Nos pacientes com doenças que acometem o parênquima hepático e que diminuem a capacidade funcional do fígado, como hepatopatias crônicas (cirrose) ou esteatose hepática acentuada, a ressecção deve preservar o máximo de parênquima hepático.Os autores relatam a experiência com três pacientes submetidos a meso-hepatectomia e discutem aspectos técni-cos, indicações e resultados deste procedimento trabalhoso e desafiador. MÉTODOOs três pacientes estudados e que serviram de base para este estudo foram: CASO 1. Paciente do sexo masculino, 55 anos, com diagnóstico de dois nódulos hepáticos sendo o primeiro de 2 cm localizado no segmento V e outro de 6 cm entre os segmentos IV e VIII. Tratava-se de paciente obeso, hiperlipêmico e que fazia uso de sinvastatina. Além disto, ingeria diariamente, há 12 anos, uma dose de destilados. A avaliação laboratorial demonstrou AST e gama-glutamil transpeptidase elevadas (duas vezes o valor normal). O restante das provas de função hepática encontrava-se normal. A biópsia percutânea, realizada em outro Serviço, demonstrou tratar-se de colangiocarcinoma.CASO 2. Paciente do sexo masculino, 57 anos, portador de hepatite crônica pelo vírus B que, após tratamento com lamivudine, apresentava viremia indetectável. As provas de funç...

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Portal Triad Clamping or Hepatic Vascular Exclusion for Major Liver Resection

Cited by 325 publications

References 13 publications

Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Intermittent inflow occlusion in living liver donors: Impact on safety and remnant function

Meso-hepatectomia: uma alternativa para a ressecção hepática alargada

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