Abstract
Background: Our purpose was to determine whether the combination of total liver vascular inflow
occlusion (Pringle maneuver) and rapid hepatic transection with a clamp-crush technique
results in significant reduction of blood loss and transfusion requirements during
major hepatic resections. Methods: A series of 49 adult patients underwent major hepatic resections for metastatic disease
between April 1, 1992, and March 31, 1998. Group 1 patients (n = 15) had standard
hilar dissection and finger-fracture hepatic transection without total liver inflow
occlusion. Group 2 patients (n = 34) had total liver inflow occlusion and clamp-crush
parenchymal transection. Results: Median blood loss was 1600 mL for group 1 and 500 mL for group 2 (P = .001). Eleven (73%) patients in group 1 required intraoperative blood transfusion
(median 2 units) compared with 7 (21%) in group 2 with a median of 0 units (P = .001 and P < .001, respectively). Of the 7 patients in group 2 who required transfusion, 3 had
a preoperative hemoglobin below 10 g/dL, 1 required splenectomy for operative injury,
and 1 underwent a concomitant complicated small bowel resection. Conclusions: Major hepatic resections can be performed without transfusion of blood products when
preoperative hemoglobin is above 10 g/dL and concomitant major surgical procedures
are not required. (Surgery 1999;125:166-71.)
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Article info
Publication history
Accepted:
August 26,
1998
Footnotes
☆Reprint requests: Jeffrey Brodsky, MD, Allegheny University Hospitals—Hahnemann Division, Department of Surgery, Broad and Vine Streets, MS #413, Philadelphia, PA 19102.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
