[Management of intraoperative and postoperative bleeding in liver surgery]

The management of bleeding in liver surgery is multidisciplinary. In most cases traumatic liver injury can be treated conservatively. Surgical treatment of severe liver trauma is associated with a high mortality rate due to extensive parenchymal and vascular injury as well as blood loss associated with the trauma. Fundamental knowledge of liver anatomy and refined surgical techniques help to reduce intraoperative blood loss and improve outcomes in elective liver surgery; nevertheless, severe blood loss and augmented transfusion requirements during extensive liver resection are still key factors for increased morbidity and mortality. Intraoperative lowering of central venous pressure and selective hepatic inflow occlusion or even total hepatic vascular exclusion are effective means of further reducing intraoperative blood loss. Furthermore, the application of sophisticated surgical instruments provides the surgeon with the potential to operate without the requirement of additional blood transfusions.