Abstract
BackgroundHemorrhage is undoubtedly one of the main factors contributing to morbidity and mortality in liver resections. Vascular occlusion techniques are effective in controlling intraoperative bleeding, but they cause liver damage due to ischemia. We evaluated the effectiveness and safety of using a combined technique for hepatic parenchymal transection without liver inflow occlusion.MethodsThree hundred and thirteen consecutive patients who underwent liver resection in four hepato-pancreato-biliary units. Hepatic parenchymal transection was carried out using a combined technique of saline-linked radiofrequency precoagulation and ultrasonic aspiration without liver inflow occlusion.ResultsDuring the study period 114 minor and 199 major hepatic resections were performed. The mean amount of intraoperative blood loss was 377 ml (SD 335 ml, range 50 to 2,400 ml) and the blood transfusion rate was 10.5%. The median amount of blood loss during parenchymal transection and parenchymal transection time was 222 ml (SD 224 ml, range 40 to 2,100 ml) and 61 minutes (range 12 to 150 minutes) respectively. There were two postoperative deaths (0.6%). Complications occurred in 84 patients (26.8%) and most complications were minor.ConclusionsCombined technique of saline-linked radiofrequency ablation and ultrasonic aspiration for liver resection is a safe method for both major and minor liver resections. The method is associated with decreased blood loss, reduced postoperative morbidity, and minimal mortality rates. We believe that this combined technique is comparable to other techniques and should be considered as an alternative.
Highlights
Hemorrhage is undoubtedly one of the main factors contributing to morbidity and mortality in liver resections
This maneuver represents a valuable tool for managing intraoperative bleeding, but at the same time places the patient at a high risk of liver damage due to ischemic reperfusion syndrome and many other complications [18,19,20,21,22,23,24]
We report the efficacy and complications of a combined technique for liver resection without liver inflow occlusion in 313 consecutive patients with primary or metastatic liver malignancies
Summary
Hemorrhage is undoubtedly one of the main factors contributing to morbidity and mortality in liver resections. The Pringle maneuver, which involves the control of the hepatic vascular inflow by clamping the hepatoduodenal ligament, represents the most simple of these methods of vascular control [18]. This maneuver represents a valuable tool for managing intraoperative bleeding, but at the same time places the patient at a high risk of liver damage due to ischemic reperfusion syndrome and many other complications [18,19,20,21,22,23,24]. One European survey revealed that 19% of surgeons apply the Pringle maneuver routinely [25]
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