[Vascular clamping of the liver. Indications and limits]

Control of bleeding during liver surgery is an essential prognostic factor for postoperative morbidity and mortality. Several well defined methods are currently available to ensure vascular occlusion, ranging from selective clamping of a segmental pedicle to total vascular exclusion of the liver. These methods of vascular control each have specific indications. However, they can induce ischaemia of the liver whose functional consequences, such as postoperative liver failure, are particularly severe in the case of prolonged ischaemia, affecting the remaining liver and in the presence of histological or functional alterations of the hepatic parenchyma. Selective methods of vascular control, only affecting the part of the liver to be resected, can be used systematically. In contrast, when the occlusion is not selective, they must be used sparingly, essentially in the case of bleeding from the parenchymal section, adopting the principal objective of the briefest possible total ischaemia. Minimization of bleeding must be weighed up against the consequences of ischaemia on the remaining liver, especially in the case of extensive hepatectomy, prolonged clamping and pathological non-neoplastic liver.