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Updated: Dec 15, 2025
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Does intermittent pringle maneuver loss its clinical value in reducing bleeding during hepatectomy? A systematic
Nanping Lin1, Jingrong Li2, Qiao Ke1
1Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Background:
The intermittent Pringle's maneuver (IPM) is conducted mainly during the procedure of hepatectomy to control intraoperative blood loss (IBL), but it has been questioned since improvement of surgical technology and intraoperative management. Hence, we conducted a systematic review and meta-analysis to validate the clinical value of IPM.
Materials And Methods:
Eligible studies that were designed to evaluate the IPM in the procedure of hepatectomy were searched for on PubMed, Medline, and other databases from establishment of the database to October 2019. The primary endpoints were IBL and intraoperative blood transfusion (IBT). The risk ratio (RR) with 95% confidence interval (CI) was used to determine the effect size.
Results:
A total of 16 studies with six randomized controlled trials (RCTs) were enrolled in this meta-analysis, including 1,770 cases in the IPM group and 1,611 cases in the non-IPM group. Overall, there were no significant differences between the IPM and non-IPM groups in the amount of IBL and the incidence of IBT (RR = 0.96, 95% CI 0.67-1.37, P = 0.82), which was also confirmed in the subgroups of RCTs (P > 0.05). However, subgroup analyses showed that for patients with colorectal liver metastasis (CRLM), the amount of IBL was generally higher in the IPM group than in the non-IPM group, and the incidence of IBT was significantly higher in the IPM group (RR = 7.17, 95% CI 1.91-26.94, P = 0.004). In addition, no significant differences were observed in terms of postoperative complications between the two groups (all P > 0.05).
Conclusion:
With the current data, we concluded that IPM had lost its value in patients with CRLM, although it remained controversial in patients with hepatocellular carcinoma.
Insights
The intermittent Pringle's maneuver (IPM) does not significantly reduce blood loss or transfusion needs during hepatectomy. However, it may increase risks for patients with colorectal liver metastasis (CRLM).
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Evidence-based medicine
Background:
- The intermittent Pringle's maneuver (IPM) is a technique used during hepatectomy to control intraoperative blood loss (IBL).
- Its clinical utility is increasingly questioned due to advancements in surgical technology and patient management.
Purpose of the Study:
- To systematically review and meta-analyze existing studies to determine the clinical value of IPM in hepatectomy.
- To assess the impact of IPM on intraoperative blood loss (IBL) and intraoperative blood transfusion (IBT).
Main Methods:
- A comprehensive search of PubMed, Medline, and other databases was conducted up to October 2019.
- Eligible studies evaluating IPM during hepatectomy were included.
- Risk ratios (RR) with 95% confidence intervals (CI) were calculated to determine effect sizes for IBL and IBT.
Main Results:
- The meta-analysis included 16 studies (1,770 patients in IPM group, 1,611 in non-IPM group).
- Overall, IPM showed no significant difference in IBL or IBT compared to non-IPM.
- For patients with colorectal liver metastasis (CRLM), IPM was associated with higher IBL and significantly higher IBT (RR=7.17, P=0.004).
Conclusions:
- IPM has lost its clinical value for patients undergoing hepatectomy for colorectal liver metastasis (CRLM).
- The role of IPM in hepatocellular carcinoma remains controversial.
- No significant differences in postoperative complications were observed between IPM and non-IPM groups.
