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Vascular occlusion to decrease blood loss during hepatic resection.

Elijah Dixon1, Charles M Vollmer, Oliver F Bathe

  • 1Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. elijah.dixon@calgaryhealthregion.ca

American Journal of Surgery
|June 24, 2005
PubMed
Summary
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Minimizing blood loss in liver surgery is crucial. Portal triad clamping (PTC) reduces bleeding, with intermittent clamping (PTC-I) often better for chronic liver disease or long surgeries.

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Vascular Surgery

Background:

  • Intraoperative blood loss is a primary hazard in liver surgery.
  • Refinement of inflow and outflow occlusive techniques aims to mitigate this risk.
  • Reviewing the utility of these techniques is essential for surgical practice.

Purpose of the Study:

  • To review the utility of different inflow and outflow occlusive techniques in hepatic surgery.
  • To compare the effectiveness of various methods in minimizing blood loss during liver resections.

Main Methods:

  • Comprehensive literature search of English-language studies (Medline, Embase, Cochrane).
  • Inclusion of terms: "liver," "hepatic," "Pringle," "total vascular exclusion," "ischemia," "reperfusion," "inflow," and "outflow occlusion."

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  • Bibliographic reviews and hand searches were also conducted.

    • Main Results:

    • Inflow occlusion techniques are generally well-tolerated for reducing blood loss.
    • Caution is advised with inflow occlusion in patients with cirrhosis, fibrosis, steatosis, cholestasis, recent chemotherapy, and for prolonged durations.
    • Portal triad clamping (PTC) shows less blood loss than no clamping.

    Conclusions:

    • Portal triad clamping (PTC) is superior to total vascular exclusion except in specific complex tumor cases.
    • For procedures under 1 hour, continuous PTC (PTC-C) and intermittent PTC (PTC-I) are comparable.
    • Intermittent PTC (PTC-I) is likely superior to continuous PTC (PTC-C) in chronic liver disease or lengthy operations.