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Updated: May 3, 2026
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Highest intraoperative lactate level could predict postoperative infectious complications after hepatectomy,
Makoto Meguro1, Toru Mizuguchi, Masaki Kawamoto
1Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. meguro@sapmed.ac.jp.
Background:
The Pringle maneuver is used to minimize blood loss during liver transection; however, it may cause reperfusion injury, which can cause increased intraoperative lactate levels and an immune compromised state. This may further lead to infectious complications.
Methods:
Here, we divided 77 patients who underwent hepatectomy between December 2007 and August 2010 into two groups: the chronic hepatitis and liver cirrhosis (CH + LC) group and normal liver (NL) group. We investigated the effect of the highest intraoperative lactate level on occurrence of infectious complications after hepatectomy by assessing the correlations of the highest intraoperative lactate level with total Pringle time, operative factors, and various parameters in serum after surgery. Parameters showing significant correlations with postoperative complications of Clavien-Dindo grade III or higher, with a wound or intra-abdominal infection, were analyzed by using interactive dot diagrams to determine cut-off values with the highest sensitivity and specificity.
Results:
We noted that, to prevent postoperative infectious complications, the highest lactate level during liver resection should be maintained at <44.0 mg/dL in the NL group and <29.0 mg/dL in the CH + LC group.
Conclusions:
Minimizing the highest intraoperative lactate level may be important to prevent increase in postoperative infectious complications after hepatectomy, reflecting the Pringle maneuver especially in chronic liver disease.
Insights
Minimizing intraoperative lactate levels during liver surgery can reduce infectious complications. Target lactate below 44 mg/dL for normal livers and 29 mg/dL for chronic liver disease patients.
Area of Science:
- Hepatobiliary Surgery
- Surgical Physiology
- Infectious Disease Prevention
Background:
- The Pringle maneuver, used in liver transection to reduce blood loss, can induce reperfusion injury.
- Reperfusion injury may elevate intraoperative lactate levels, potentially compromising the immune system and increasing infection risk.
- Postoperative infectious complications are a significant concern following hepatectomy.
Purpose of the Study:
- To investigate the correlation between the highest intraoperative lactate level and the occurrence of infectious complications after hepatectomy.
- To determine optimal lactate level thresholds for preventing postoperative infections in patients undergoing liver resection.
Main Methods:
- A cohort of 77 patients undergoing hepatectomy was divided into normal liver (NL) and chronic hepatitis and liver cirrhosis (CH + LC) groups.
- The study assessed correlations between the highest intraoperative lactate level, Pringle maneuver duration, operative factors, and postoperative serum parameters.
- Interactive dot diagrams were used to identify cut-off lactate values for predicting severe complications (Clavien-Dindo grade III or higher) and infections.
Main Results:
- The highest intraoperative lactate level should be maintained below 44.0 mg/dL in the NL group to prevent infectious complications.
- For the CH + LC group, the highest intraoperative lactate level should be kept below 29.0 mg/dL to mitigate infectious complication risk.
- Specific lactate thresholds were identified with high sensitivity and specificity for predicting postoperative infectious complications.
Conclusions:
- Controlling the highest intraoperative lactate level is crucial for preventing postoperative infectious complications after hepatectomy.
- This strategy is particularly important in patients with chronic liver disease undergoing procedures involving the Pringle maneuver.
- Maintaining low intraoperative lactate levels may help mitigate the adverse effects of reperfusion injury and improve patient outcomes.
