Liver resections can be performed safely without Pringle maneuver: A prospective study

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• The Pringle maneuver is a standard technique to control bleeding during liver resections.
• Concerns exist regarding potential Pringle maneuver-induced liver injury and delayed recovery.

Purpose of the Study:

• To evaluate the safety and feasibility of liver resections performed without the Pringle maneuver.
• To assess the impact of avoiding portal triad clamping on patient outcomes.

Main Methods:

• A prospective study of 175 liver resections (101 major anatomical, 74 large atypical) performed without Pringle maneuver between 2002 and 2013.
• Water-jet dissection was used for liver parenchyma dissection; median central venous pressure was maintained at 4 mmHg.

Main Results:

• The study included 127 patients undergoing 143 procedures. Median patient age was 60 years.
• Median blood loss was 400 mL, with 15% requiring perioperative blood transfusions. One postoperative death occurred; two patients experienced temporary liver failure.

Conclusions:

• Major liver resections can be safely performed without the Pringle maneuver.
• Avoiding intraoperative liver inflow clamping may mitigate liver damage and failure, potentially leading to shorter hospital stays.