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One hundred consecutive hepatic resections. Blood loss, transfusion, and operative technique
J D Cunningham1, Y Fong, C Shriver
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Archives of Surgery (Chicago, Ill. : 1960)
|October 1, 1994
Summary
Standard surgical techniques for hepatic resection effectively control blood loss and transfusion needs. This approach is safe, cost-effective, and suitable for widespread clinical application.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Transfusion Medicine
Background:
- Hepatic resection is associated with significant blood loss, necessitating improved surgical methods.
- Adverse effects of blood loss and transfusion require enhanced techniques to minimize requirements.
Purpose of the Study:
- To evaluate the efficacy of standard surgical techniques in managing blood loss and transfusion requirements during hepatic resection.
- To assess the safety, cost-effectiveness, and reproducibility of these surgical methods.
Main Methods:
- One hundred hepatic resections were performed using standard techniques: hilar structure control, extrahepatic control of hepatic veins, and the Pringle maneuver.
- Low central venous pressure and Trendelenburg positioning were employed during parenchymal transection.
- Data collection was retrospective for the first 36 patients and prospective for the remaining 64.
Main Results:
- Hospital mortality was 3%. Median blood loss varied by resection type, ranging from 450 mL (segmental) to 1500 mL (extended left).
- Major resections showed higher transfusion rates for albumin, fresh frozen plasma, and packed red blood cells/whole blood.
- In the prospective group, autologous blood predeposit reduced homologous transfusions from 56% to 38%.
Conclusions:
- The employed surgical techniques achieve acceptable blood loss and transfusion rates in hepatic resection.
- This standardized approach is safe, cost-effective, reproducible, and suitable for broad implementation.