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Intraperitoneal and Extraperitoneal Pringle Hepatic Hilar Occlusion in Laparoscopic Liver Resection: A Prospective
Liang He1, Wei-Xiang Li2, Da-Chen Zhou1
1Department of General Surgery, The Second Hospital of Anhui Medical University, Hefei, 230601, China.
Current Medical Science
|November 20, 2024
Summary
Intraperitoneal Pringle maneuver (IPM) with bulldog clamps is a safe and effective method for laparoscopic liver resection, leading to reduced inflammation and faster recovery compared to extraperitoneal Pringle maneuver (EPM).
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Laparoscopic liver resection (LLR) is increasingly common.
- Effective hepatic hilar occlusion is crucial for LLR safety and efficacy.
- The Pringle maneuver is a standard technique for controlling hepatic inflow.
Purpose of the Study:
- To evaluate the safety and efficacy of the Pringle maneuver using bulldog clamps in LLR.
- To compare intraperitoneal Pringle maneuver (IPM) with extraperitoneal Pringle maneuver (EPM).
Main Methods:
- Prospective randomized controlled study.
- 80 patients undergoing LLR were enrolled (40 IPM, 40 EPM).
- Key outcomes included operative time, blood loss, liver function tests, and hospital stay.
Main Results:
- IPM demonstrated shorter occlusion and operation times than EPM.
- No significant differences in immediate postoperative liver function (ALT, AST, TBIL, ALB).
- IPM group showed lower C-reactive protein (CRP) levels, reduced liver enzyme elevation on days 3-5, and shorter hospital stay.
Conclusions:
- Intraperitoneal Pringle maneuver (IPM) with bulldog clamps is simple, safe, and effective for LLR.
- IPM is associated with a less severe inflammatory response and lower degree of liver injury.
- Patients undergoing IPM experience faster recovery post-laparoscopic liver resection.
