Abstract
The aim of the present study was to assess the advantages and disadvantages of liver vascular partial exclusion (LVPE) (liver dysfunction due to ischemia) during liver resection in patients submitted to partial hepatectomy. A total of 114 patients were submitted to partial hepatectomy (minor versus major resections) with LPVE being used in 57 of them but not in the remaining 57. Patient age ranged from 35 to 73 years and 57 % were women. Mitochondrial function was assessed 30 minutes after liver resection in the remnant liver and serum aminotransferases were determined before surgery and for seven days postoperatively. LPVE time ranged from 30 to 60 minutes. Data were analyzed statistically by the Student T test (5 % level of significance). Mitochondrial function was similar in the minor and major liver resections. The maximum postoperative aminotransferase peak was similar in the groups with and without LPVE. LPVE did not induce mitochondrial changes in hepatic tissue in either type of surgery, and aminotransferase levels were similar for patients with and without LPVE. Thus, the results show that LPVE is a safe procedure that does not induce the significant changes typical of ischemia and reperfusion in the liver remnant.
Highlights
Partial liver resection for the treatment of malignant or benign liver tumors, may be complicated by intraoperative bleeding1,2,3,4
With the improved technical training of surgical teams and with the development of new generations of ultrasound, harmonic and water-jet scalpels and the argon cautery, the level of hemorrhage has been reduced during hepatectomy, bleeding continues to be a factor of intra- and postoperative complications in liver resection7,8,9
The aim of the present study was to assess the advantages and disadvantages of liver partial vascular exclusion (LPVE) during liver resection in patients submitted to partial hepatectomy
Summary
Partial liver resection for the treatment of malignant or benign liver tumors, may be complicated by intraoperative bleeding. The concept of hepatic vascular control is based on the proven tolerance of liver to warm ischemia and on strong evidence that liver tolerates ischemia better than bleeding5,6,10 It should be taken into account that vascular control eliminates bleeding only during the phase of parenchymal transection and is not beneficial during the phase of liver mobilization, when bleeding may occur. In this phase of liver dissection the complications have been minimized with the increasing experience gained by the surgeons, especially in liver transplantation. The aim of the present study was to assess the advantages and disadvantages of liver partial vascular exclusion (LPVE) (liver dysfunction due to ischemia) during liver resection in patients submitted to partial hepatectomy
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