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Reduction of transfusion requirements during major hepatic resection for metastatic disease
1Department of Surgery, Allegheny University Hospitals-Hahnemann Division, Philadelphia, Pa. 19102, USA.
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.