One Hundred Hepatectomies without Hospital Death under Intermittent Hepatic Inflow Clamping for 30 Minute Duration

Temporary clamping of the hepatic inflow is routinely applied to minimize haemorrhage during liver parenchyma. In this report, we describe successful intermittent application of the hepatic inflow for 30 minutes with zero hospital death in consecutive 100 hepatectomies.

One hundred consecutive patients undergoing elective liver resection were entered for this prospective study. A synthetic protease inhibitor (gabaxate mesilate, GM) was intravenously administrated continuously starting 12 hours before the operation until the second postoperative day. The patients underwent hepatectomy with a cycle consisting of intermittent application of inflow clamping for 30 minutes, followed by 5 minutes of declamping. Intraoprative data were evaluated together with complications and hospital death rates. Liver function tests were performed on postoperative days, 1, 3 and 7.

All the patients discharged the hospital with a zero motality and an average hospital stay of 8 days postoperatively. Peak for aminotransferase were observed postoperative day 1 (382 ± 268, 245 ± 204 IU/L, mean ± SD for serum S-AST and S-ALT). The bilirubin and prothrombin times were normalized day 7 postsurgery. There were no differences between GM protocols.

We have successfully confirmed that a cycle consisting of intermittent application of the hepatic inflow clamping yields safe hepatectomy under effective control of bleeding, when combined with use of a protease inhibitor.