Hepatic resection under the intermittent selective portal branch occlusion by balloon catheter

In hepatic resection, it is important to control intrahepatic blood flow to minimize blood loss. Intermittent and selective vascular occlusion, if possible, are advisable.

For this purpose, we created the double balloon catheter, which when introduced into a lobar or a smaller branch of the intrahepatic portal vein through a branch of the ileocolic vein, made it possible to occlude these branches temporarily during hepatic resection. The small balloon located at the tip of the catheter made it easy to introduce the catheter to the portal branch selectively, under the guidance of ultrasonography. Another balloon was inflated intermittently to occlude selective portal blood flow. Using this technique, hepatic resection was achieved in 18 consecutive patients: 13 with hepatocellular carcinomas (11 with cirrhosis, two with chronic hepatitis), one with cholangiocellular carcinoma, three with metastatic carcinomas, and one with intrahepatic calculi.

In these cases, 19 hepatic resections were performed; two left hepatectomies, one extended right hepatectomy, one right hepatectomy, six segmentectomies, eight subsegmentectomies, and one partial hepatectomy. In each case, well demarcated hepatic tissue delineated by ischemic change was removed with minimal bleeding and little impairment to the residual hepatic tissue, resulting in a good postoperative course.

This double balloon catheter can replace the dissection of the hepatoduodenal ligament for hepatic resection, which causes bleeding, especially in patients with cirrhosis, and results in less cell injury of the residual hepatic parenchyma.