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Intermittent total pedicular clamping in hepatic resections in non-cirrhotic patients
Rafael Omar Giovanardi1, Henrique Joäo Giovanardi, Mary Bozetti
1Department of General Surgery, Universidade de Caxias do Sul and General Hospital, Caxias do Sul, Brazil. giovar@terra.com.br
Background/Aims:
Evaluation of intermittent total pedicular clamping in hepatic resections in non-cirrhotic patients.
Methodology:
A prospective study was made of 72 patients submitted to hepatic resections using intermittent total pedicular clamping. Patients were placed in 5 groups for analysis according to the duration of liver ischemia (each 20 minutes). Tolerance of liver ischemia was assessed by analysis of postoperative morbimortality and biochemical test.
Results:
Five patients (6.9%) died during the postoperative period and sixteen patients (23.8%) developed specific complications, however, none of the variables analyzed in this study proved to be an independent risk factor for the development of postoperative morbimortality. The transaminases presented a statistically significant relationship with duration of ischemia (P < 0.002), while the late rise was influenced by postoperative mortality (P < 0.009). Prothrombin time was influenced by the duration of ischemia and by postoperative mortality (P = 0.014) but, on the other hand, the bilirubin levels only showed the influence of mortality (P < 0.002).
Conclusions:
Immediate postoperative liver function was better preserved in patients submitted to less than 80 minutes of clamping. The late rise of bilirubin and transaminases and the drop in prothrombin time could be considered indicators of a bad postoperative course.