[Pedicular clamping in major hepatectomies: clamping "of principle" or "of necessity"? A comparative study]

Fifty-two consecutive patients undergoing major hepatic resection for liver tumor were divided into two groups according to the operative procedure. Group A consisted of 34 patients in whom vascular inflow occlusion was performed "de principle" during parenchymal division and intrahepatic approach of the portal structures; the mean duration of the portal triad clamping was 43 mn (ranged 17 to 70 mn). Group B patients (18 cases) had hilar division of the structures of that portion of the liver due to be removed, prior to parenchymal division was performed without vascular arrest, except in five "de necessitate" cases during 5 to 22 mn. Groups A and B were comparable in terms of patient age or status, of king of liver tumors and extent of resection. Mean operating duration (215 vs 263 mn), volume of intraoperative blood transfusion (557 vs 1019 ml), intensive care (2.5 vs 4.2 days) and total hospital stays (19.6 vs 30.5 days) were significantly reduced in group A. A higher but transient increase of amino-transferase level was the only biochemical consequence of liver ischemia in group A, whereas postoperative disturbance in serum bilirubin, prothrombin time, fibrinogen, and total protein were significantly greater in group B, probably because of the greater volume of blood transfusion in this group. Thus, routine vascular inflow occlusion with transhepatic approach of the portal structures may be an effective and innocuous procedure for major liver resection.