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When does a Pringle Maneuver cause harm?

Alexander M Fagenson1, Elizabeth M Gleeson2, Fatima Nabi3

  • 1Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA 19140, USA.

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
|September 16, 2020
PubMed
Abstract

Insights

The Pringle Maneuver (PM) increases operative time. While generally safe, it is linked to worse outcomes like liver failure and septic shock in partial hepatectomy patients and those with metastatic disease.

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Outcomes Research
  • Clinical Effectiveness Analysis

Background:

  • The Pringle Maneuver (PM) is a widely used technique in liver surgery.
  • Existing data on perioperative outcomes following the PM are conflicting.
  • There is a need to clarify the safety and efficacy of the PM in specific patient populations.

Purpose of the Study:

  • To compare perioperative outcomes between patients who underwent a Pringle Maneuver (PM) and those who did not.
  • To analyze outcomes based on hepatectomy extent, liver texture, and pathology.
  • To identify patient subgroups that may experience adverse outcomes with the PM.

Main Methods:

  • Retrospective analysis of the 2014-2017 ACS-NSQIP hepatectomy database.
  • Inclusion of patients undergoing major (≥3 segments) or partial (≤2 segments) hepatectomy.
  • Utilization of propensity matching to compare outcomes between PM and non-PM groups, with subgroup analyses.

Main Results:

  • The Pringle Maneuver (PM) was used in 24% of 15,748 hepatectomy patients.
  • After propensity matching, operative time was significantly longer for patients who underwent a PM (246 vs. 225 minutes).
  • Post-hepatectomy liver failure and septic shock rates were significantly higher in PM patients undergoing partial hepatectomy or with metastatic disease.

Conclusions:

  • The Pringle Maneuver (PM) is associated with increased operative time.
  • Outcomes are worse for patients undergoing partial hepatectomy with the PM.
  • Patients with metastatic disease also experience poorer outcomes when the PM is employed.

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