Outcome of Major Liver Resections with Routine Use of Pringle’s Maneuver: Single Team Experience from Developing HPB Unit of University Teaching Hospital

Abstract

Background: With improved perioperative care and improvement in surgical techniques have led to excellent outcomes following major liver resections. Inflow occlusion is selectively used these days. However, at our center, we routinely use Pringle‘s Maneuver during major liver resections. This study is done to analyze the outcome of major liver resections with routine use of Pringle’s Maneuver. Method: Retrospective review of the medical records of the patients (Oct 2011 to July 2021) undergoing major liver resections performed by single team with routine use of Pringle’s Maneuver was analyzed. Major liver resections were defined by resections of three or more segments of liver. Indications, types of resections, various preoperative and intraoperative parameters including blood loss, duration of surgery and postoperative outcomes according to Clavien Dindo classification was performed. Incidence of Post hepatectomy liver failure (PHLF) and other liver surgery specific complications were also analyzed. Results: Total 65 major liver resections with Pringle‘s maneuver was performed, 13 extended resections, 20 right, 16 left and 16 nonanatomical resections. Average inflow occlusion was 20 minutes (Range: 5- 30 minutes). Postoperative morbidity was 30%. Blood transfusion required in 13(20%). Liver specific complications included bile leak (7, 10.7%), PHLF (5, 7.6%). There was single perioperative mortality. Conclusion: Perioperative outcomes of major liver resections with the use of Pringle ‘s maneuver is in acceptable range.