Bleeding in liver surgery: prevention and treatment

Area of Science:

• Hepatobiliary Surgery
• Surgical Hemostasis
• Transfusion Medicine

Background:

• Intraoperative blood loss and blood product transfusion negatively impact outcomes after liver surgery.
• Effective strategies are needed to minimize bleeding during these procedures.

Purpose of the Study:

• To review methods for reducing intraoperative blood loss in liver surgery.
• To evaluate the efficacy of different hemostatic strategies, including surgical techniques and blood product management.

Main Methods:

• Review of surgical techniques for blood loss reduction, such as vascular clamping and topical hemostatic agents.
• Analysis of the role of central venous pressure management.
• Evaluation of preoperative correction of coagulation tests and the use of antifibrinolytic and systemic hemostatic drugs.

Main Results:

• Surgical methods like vascular clamping and topical hemostatics can minimize blood loss.
• Maintaining low central venous pressure is effective in reducing bleeding during partial liver resections.
• Prophylactic blood transfusions and preoperative correction of coagulation tests have not shown benefit and may increase bleeding risk.
• Antifibrinolytic drugs are effective in liver transplantation but systemic hemostatic drugs have limited value in partial liver resections.

Conclusions:

• Surgical techniques and low central venous pressure management are key to reducing blood loss in liver surgery.
• Volume contraction is preferred over prophylactic transfusions in major liver surgery.
• The utility of systemic hemostatic drugs is limited in partial liver resections, unlike in liver transplantation.