Vascular inflow exclusion and hepatic resection

Taniguchi, Hiroki; Takahashi, Toshio; Shioaki, Yasuhiro; Itoh, A.; Oguro, Atsushi

doi:10.1002/bjs.1800790726

Cited by 15 publications

(7 citation statements)

References 14 publications

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“…On the contrast, Tanaka et al [40] reported there were no differences between two groups in the perioperative data. Taniguchi et al [41] reported that though there were no significant difference in blood loss and operative time between Pringle maneuver group and no vascular occlusion group, and the liver enzymes and total bilirubin were elevated in Pringle group.…”

Section: Discussionmentioning

confidence: 96%

Comparing Outcomes of Two Vascular Inflow Occlusion Techniques and Treatment without Vascular Occlusion during Major Hepatectomy in Patients with Hepatitis B-Related Hepatocellular Carcinoma

et al. 2014

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BackgroundSignificant hemorrhage together with blood transfusion has negative impact on postoperative morbidity, mortality, and long-term survival of liver resection. Various techniques of vascular occlusion have been developed to reduce intraoperative blood loss. The objective of this study was to compare the outcomes of Pringle maneuver, hemi-hepatic vascular occlusion, and treatment without vascular occlusion used during liver resection.MethodData of 574 patients with Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), who underwent major hepatectomy between January 2009 to March 2013 by Pringle maneuver (N = 158), hemi-hepatic vascular inflow occlusion (N = 216), or without any vascular occlusion (N = 200), were included in this retrospective study. Perioperative blood transfusion, intraoperative blood loss, and postoperative liver function, and surgical complications were analyzed and compared between the three groups.ResultThere were no significant difference observed in postoperative bilirubin, liver enzyme, and albumin levels between three groups (P>0.05). 5 patients (2.5%) in no occlusion group, 2 (1.3%) in Pringle group, and 8 (3.7%) in hemi-hepatic group had liver failure; but, there were no differences (P>0.05). The overall postoperative complications rate between three groups did not reach significant differences (33.5% vs 34.2% vs 42.6%, respectively; P>0.05). However, significant differences in intraoperative blood loss between no occlusion group (638.2±426.8 ml) and Pringle group (518.0±451.0 ml) or hemi-hepatic group (513.0±366.7 ml) (P<0.01).ConclusionAlthough there were no differences found between three groups regarding postoperative complications rate, no vascular occlusion group had more blood loss than the other two groups during liver resection.

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Section: Discussionmentioning

confidence: 96%

Comparing Outcomes of Two Vascular Inflow Occlusion Techniques and Treatment without Vascular Occlusion during Major Hepatectomy in Patients with Hepatitis B-Related Hepatocellular Carcinoma

et al. 2014

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“…Patients who required concomitant bowel resection were not included. The intermittent Pringle maneuver was applied at the time of liver transection and consisted of cross-clamping the hepatoduodenal ligament (and the aberrant left hepatic artery if present) for 20 minutes and releasing the clamp for 5 AKBR was measured before, during, and after liver transection and then hourly for 4 hours. Accurate measurements of blood loss were made before, during, and after liver transection.…”

Section: Randomizationmentioning

confidence: 99%

Prospective Evaluation of Pringle Maneuver in Hepatectomy for Liver Tumors by a Randomized Study

Man

Fan²,

Ng³

et al. 1997

Annals of Surgery

414

307

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ObjectiveTo evaluate whether vascular inflow occlusion by the Pringle maneuver during hepatectomy can be safe and effective in reducing blood loss. Summary Background DataHepatectomy can be performed with a low mortality rate, but massive hemorrhage during surgery remains a potentially lethal problem. The Pringle maneuver is traditionally used during hepatectomy to reduce blood loss, but there is a potential harmful effect on the metabolic function of hepatocytes. There has been no prospective randomized study to determine whether the Pringle maneuver can decrease blood loss during hepatectomy, improve outcome, or affect the metabolism of hepatocytes. MethodsFrom July 1995 to February 1997, we studied 100 consecutive patients who underwent hepatectomy for liver tumors. The patients were randomly assigned to liver transection under intermittent Pringle maneuver of 20 minutes and a 5-minute clamp-free interval (n = 50), or liver transection without the Pringle maneuver (n = 50). The surface area of liver transection was measured and blood loss during transection per square centimeter of transection area was calculated. Routine liver biochemistry, arterial ketone body ratio (AKBR), and the indocyanine green (ICG) clearance test were done. ResultsThe two groups were comparable in terms of preoperative liver function and in the proportion of patients having major hepatectomy. The Pringle maneuver resulted in less blood loss per square centimeter of transection area (12 mUcm2 vs. 22 mUcm2, p = 0.0001), a shorter transection time per square centimeter of transection area (2 min/cm2 vs. 2.8 min/cm2, p = 0.016), a significantly higher AKBR in the first 2 hours after hepatectomy, lower serum bilirubin levels in the early postoperative period, and, in cirrhotic patients, higher serum transferrin levels on postoperative days 1 and 8. The complication rate, the hospital mortality rate, and the ICG retention at 15 minutes on postoperative day 8 were equal for the two groups. 704

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“…Some reported adverse effects to the liver in cirrhotic patients [24]. Some authors have reported acceptable outcomes after hepatic resection without the use of the Pringle maneuver [25][26][27]. Man et al reported that the Pringle maneuver was associated with less blood loss and better preservation of hepatic function postoperatively [28].…”

Section: Discussionmentioning

confidence: 99%

Hepatic resection using ultrasonic surgical aspirator

Sriussadaporn

Pak‐art

et al. 2015

Asian Biomedicine

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Background Hepatic resections conducted for malignant tumors can be difficult because of the need to create cancer-free margins. Objectives To examine the outcome of hepatic resections after the introduction of a Cavitron Ultrasonic Surgical Aspirator (CUSA). Methods A retrospective study of patients who underwent hepatic resection by a single surgeon between April 1999 to March 2013. Results We included 101 patients with 104 hepatectomies. Most hepatic parenchymal transections were performed using a CUSA under intermittent hepatic inflow occlusion (Pringle maneuver). Thirty-five patients underwent a right hepatectomy, 11 a left hepatectomy, 6 a right hepatectomy and segment I resection, 6 a right lobectomy, and 46 underwent segmentectomies, wedge resections, or other types of hepatic resections. Biliary-enteric reconstruction with a Roux-en-Y limb of the jejunum to a hepatic duct of the hepatic remnant was performed in 28 patients. Operative time was 90–720 min (median 300 min, mean 327 ± 149 min). Operative blood transfusion was 0–17 units (median 3 units, mean 3.9 ± 3.6 units). Twenty-one hepatectomies were conducted without blood transfusion. Thirty-four postoperative complications occurred in 30 patients with a 9% reoperation rate. Perioperative mortality was 6%. Age, operative time, operative blood transfusion, reoperation, and complications were significantly associated with mortality. Conclusion Careful preoperative diagnosis and evaluation of patients, faultless surgical techniques, and excellent postoperative care are important to avoid potentially serious postoperative complications and mortality. The CUSA is an effective assisting device during hepatic parenchymal transection with a concomitant Pringle maneuver, apparently reducing operative blood loss.

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Vascular inflow exclusion and hepatic resection

Cited by 15 publications

References 14 publications

Comparing Outcomes of Two Vascular Inflow Occlusion Techniques and Treatment without Vascular Occlusion during Major Hepatectomy in Patients with Hepatitis B-Related Hepatocellular Carcinoma

Comparing Outcomes of Two Vascular Inflow Occlusion Techniques and Treatment without Vascular Occlusion during Major Hepatectomy in Patients with Hepatitis B-Related Hepatocellular Carcinoma

Prospective Evaluation of Pringle Maneuver in Hepatectomy for Liver Tumors by a Randomized Study

Hepatic resection using ultrasonic surgical aspirator

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