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Published on: June 16, 2023
Meta-analysis of intermittent Pringle manoeuvre versus no Pringle manoeuvre in elective liver surgery
Pandanaboyana Sanjay1, Ian Ong, Adam Bartlett
1Department of HPB Surgery, Royal Infirmary, Edinburgh, UK.
Background And Objectives:
Intermittent Pringle manoeuvre (IPM) is frequently used during liver surgery. This meta-analysis aimed to review the impact on blood loss, operating time and morbidity and mortality with and without use of IPM.
Methods:
An electronic search was performed of the MEDLINE, EMBASE, PubMed databases using both subject headings (MeSH) and truncated word searches to identify all articles published that related to this topic. Pooled risk ratios were calculated for categorical outcomes, and mean differences (MDs) for secondary continuous outcomes, using the fixed-effects and random-effects models for meta-analysis.
Results:
Four randomized controlled trials encompassing 392 patients were analysed to achieve a summated outcome. Pooled data analysis showed the use of IPM resulted in reduced transection time/cm(2) (MD -0.53 (-0.88, -0.18) min/cm(2) (P = 0.003)) but with comparable blood loss (mL/cm(2)) (MD -1.67 (-4.41, 1.08) mL/cm(2), P = 0.23), overall blood loss (MD -20.42 (-89.42, 48.58) mL), blood transfusion requirements (risk ratio 0.78 (0.40, 1.52, P = 0.47)) and morbidity and mortality compared to no Pringle manoeuvre. In addition, there was no significant difference in the post-operative hospital stay (MD 0.37 (-0.60, 1.34) days).
Conclusions:
There is no evidence that the routine use of IPM improves perioperative and post-operative outcomes compared to no Pringle manoeuvre and its routine may not be recommended.
Insights
The intermittent Pringle manoeuvre (IPM) in liver surgery did not significantly reduce blood loss or improve patient outcomes. Routine use of IPM is not recommended based on current evidence.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Clinical outcomes research
Background:
- The intermittent Pringle manoeuvre (IPM) is a common technique during liver surgery to control blood flow.
- Its routine application's impact on perioperative outcomes requires thorough evaluation.
Purpose of the Study:
- To conduct a meta-analysis evaluating the effect of intermittent Pringle manoeuvre (IPM) on blood loss, operating time, and patient morbidity and mortality during liver surgery.
Main Methods:
- A systematic electronic literature search was conducted across MEDLINE, EMBASE, and PubMed.
- Four randomized controlled trials involving 392 patients were included.
- Pooled risk ratios and mean differences were calculated using fixed-effects and random-effects models.
Main Results:
- Intermittent Pringle manoeuvre (IPM) use was associated with reduced transection time per cm² (P=0.003).
- No significant differences were observed in blood loss, transfusion requirements, morbidity, mortality, or post-operative hospital stay.
- P-values for comparable outcomes ranged from 0.23 to 0.47.
Conclusions:
- Current evidence does not support the routine use of intermittent Pringle manoeuvre (IPM) for improving perioperative or post-operative outcomes in liver surgery.
- The routine implementation of IPM may not be advisable.
