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Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Hepatic Pedicle Occlusion with the Pringle Maneuver During Difficult Laparoscopic Cholecystectomy Reduces the
Rongce Zhao1, Fei Liu1, Chenyang Jia1
1Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan Province, China.
Insights
The Pringle maneuver, a hepatic pedicle occlusion technique, significantly reduces complications and costs during difficult laparoscopic cholecystectomy (LC). This method improves surgical field clarity, lowers conversion rates, and enhances patient outcomes in challenging LC procedures.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Procedures
- Surgical Safety
Background:
- Hemorrhage during laparoscopic cholecystectomy (LC) is common in cases of cholecystitis or portal hypertension due to fragile vessels.
- Bleeding can impair surgical visibility, increasing conversion rates and the risk of common bile duct injury.
- The Pringle maneuver temporarily occludes hepatic pedicle blood flow, potentially improving surgical field clarity.
Purpose of the Study:
- To evaluate the feasibility, effectiveness, and safety of using the Pringle maneuver for hepatic pedicle occlusion during difficult LC.
- To determine if this technique can reduce complications and improve outcomes in challenging LC cases.
Main Methods:
- A retrospective study comparing 67 patients undergoing LC with the Pringle maneuver (Pringle group) to 67 matched controls without the maneuver (non-Pringle group).
- Data collected included conversion rates, blood loss, postoperative hospitalization duration, and costs.
- Patient outcomes and complications were analyzed between the two groups.
Main Results:
- The Pringle group demonstrated significantly lower conversion rates (1.49% vs. 11.9%), reduced blood loss (37.5 mL vs. 94.5 mL), shorter hospital stays (2.5 days vs. 3.5 days), and lower costs ($1343 vs. $1674).
- No bile duct injuries or 30-day readmissions for bile leakage occurred in the Pringle group, compared to one case each in the non-Pringle group.
- The Pringle maneuver provided a clearer surgical field, facilitating better recognition of anatomical structures.
Conclusions:
- Hepatic pedicle occlusion via the Pringle maneuver is a feasible and safe approach for difficult LC.
- This technique effectively improves surgical field visualization, reduces conversion rates, and leads to better patient outcomes.
- The Pringle maneuver is a valuable tool for managing bleeding and enhancing safety during complex laparoscopic cholecystectomies.
Background:
In the presence of cholecystitis or portal hypertension, hemorrhage is common during laparoscopic cholecystectomy (LC) because the vessels of Calot's triangle are fragile and tortuous. Bleeding can obstruct surgical field visibility and increase conversion rates and risk of common bile duct injury. The Pringle maneuver is a simple occlusion approach that could limit blood flow from the hepatic pedicle, thus controlling bleeding to provide a clear surgical field to reduce conversion rate. In this study, we aimed to investigate the feasibility, effectiveness and safety of hepatic pedicle occlusion with the Pringle maneuver during difficult LC.
Methods:
From 2011 to 2015, LC with hepatic pedicle occlusion by the Pringle maneuver was performed in 67 patients (Pringle group). Another group of 67 cases with matched clinical parameters where LC was performed without the Pringle maneuver (non-Pringle group) was retrieved from a database to serve as the control group.
Results:
The Pringle group had a significantly lower conversion rate (1.49% vs. 11.9%; P = 0.038), less blood loss (37.5 ± 24.1 mL vs. 94.5 ± 67.8 mL; P = 0.002), shorter postoperative hospitalization (2.5 ± 1.4 days vs. 3.5 ± 2.5 days; P = 0.005), and lower cost ($1343 ± $751 USD vs. $1674 ± $609 USD; P = 0.024) than non-Pringle group. There was one case each of bile duct injury and readmission within 30 days because of bile leakage in the non-Pringle group, but none in the Pringle group.
Conclusions:
Hepatic pedicle occlusion could provide a clear surgical field and enable the recognition of structures during LC. The Pringle maneuver offers a feasible and safe approach to lower conversion rates in difficult LC.
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