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Updated: Aug 6, 2025
Application of Hemostatic Devices in Laparoscopic Hepatectomy
Published on: April 19, 2022
Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and
Hui Ye1, Hanghang Wu2, Bin Li3
1Department of Anesthesiology, ZhongDa Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Nanjing, Jiangsu Province, 210009, China. carciapene@126.com.
Insights
Lowering central venous pressure (CVP) during hepatectomy significantly reduces blood loss and transfusion needs. Acute normovolaemic haemodilution and autologous blood donation also decrease transfusion requirements, improving patient outcomes.
Area of Science:
- Hepatobiliary surgery
- Anesthesiology
- Transfusion medicine
Background:
- Perioperative bleeding and allogeneic blood transfusions impact patient outcomes in hepatectomy.
- This meta-analysis evaluates cardiovascular interventions for managing blood loss and transfusion during liver resections.
Approach:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) up to February 2023.
- Included RCTs focused on interventions to reduce blood loss or transfusion in hepatectomy patients.
- Primary outcomes: blood loss, transfusion rates, and postoperative complications; Secondary outcomes: operating time, mortality, organ function, and hospital stay.
Key Points:
- Low central venous pressure (CVP) group showed significantly less operative bleeding (MD: -409.75 mL), reduced transfusion rates (RR: 0.47), shorter operating times (MD: -13.42 min), and fewer complications (RR: 0.76) compared to controls.
- Acute normovolaemic haemodilution (ANH) and autologous blood donation reduced transfusion needs but not blood loss.
- No significant benefits observed for mortality rates or hospital stay length across interventions.
Conclusions:
- Maintaining a low CVP is an effective and safe strategy for adult hepatectomy patients.
- ANH and autologous blood donation can be valuable components of blood management for selected patients.
- Further research may explore optimizing these strategies to further improve surgical outcomes.
Background:
Perioperative bleeding and allogeneic blood transfusion are generally thought to affect the outcomes of patients. This meta-analysis aimed to determine the benefits and risks of several cardiovascular interventions in patients undergoing hepatectomy.
Methods:
In this systematic review and meta-analysis, randomised controlled trials (RCTs) were searched in the Cochrane Library, Medline, Embase, and Web of Science to February 02, 2023. RCTs focused on cardiovascular interventions aimed at reducing blood loss or blood transfusion requirements during hepatectomy were included. The primary outcomes were perioperative blood loss amount, number of patients requiring allogeneic blood transfusion and overall occurrence of postoperative complications. The secondary outcomes were operating time, perioperative mortality rate, postoperative liver and kidney function and length of hospital stay.
Results:
Seventeen RCTs were included in the analysis. A total of 841 patients who underwent hepatectomy in 10 trials were included in the comparative analysis between low central venous pressure (CVP) and control groups. The forest plots showed a low operative bleeding volume [(mean difference (MD): -409.75 mL, 95% confidence intervals (CI) -616.56 to -202.94, P < 0.001], reduced blood transfusion rate [risk ratio (RR): 0.47, 95% CI 0.34 to 0.65, P < 0.001], shortened operating time (MD: -13.42 min, 95% CI -22.59 to -4.26, P = 0.004), and fewer postoperative complications (RR: 0.76, 95% CI 0.58 to 0.99, P = 0.04) in the low CVP group than in the control group. Five and two trials compared the following interventions, respectively: 'acute normovolaemic haemodilution (ANH) vs control' and 'autologous blood donation vs control'. ANH and autologous blood donation could not reduce the blood loss amount but greatly decreased the number of patients requiring allogeneic blood transfusion. No benefits were found in the rate of mortality and length of postoperative hospital stay in any of the comparisons.
Conclusion:
Lowering the CVP seems to be effective and safe in adult patients undergoing hepatectomy. ANH and autologous blood donation should be used as a part of blood management for suitable patients in certain circumstances.
Trial Registration:
PROSPERO, CRD42022314061.
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