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Major liver resections without vascular clamping: retrospective study of 84 cases
B Descottes1, P Thognon, D Valleix
1Department of Digestive Surgery and Transplantation, Dupuytren University Hospital, Limoges, France.
Background/Aims:
The question as to whether vascular clamping aggravates mortality and morbidity of major liver resection was investigated in this study. Major liver resection with vascular clamping for parenchyma transection has mortality between 0 and 5%, and higher morbidity reaching 47% with healthy liver in recent report.
Methodology:
Eighty-four major liver resection without vascular clamping were carried out between January 1986 to December 1996 were reviewed. There were 57 men and 27 women with average age of 58.2 (12.2) years old. Indications of resection were adenoma (4.8%) angioma (11.9%) focal nodular hyperplasia (1.2%) hematoma (1.2%) metastases (60.7%) hepatocellular carcinoma (14.3%) and cholangiocarcinoma (5.9%). Resections used ultrasonic dissector (Sonoca) with intraoperative ultrasonography were right hepatectomy in 56 cases extended right hepatectomy in 10 cases left hepatectomy in 17 cases and middle hepatectomy in 1 case. Remnant liver was cirrhotic in 3 cases.
Results:
Three patients died (3.5%) and the rate of major complications were 11.2%. 46 patients (54.8%) had no blood transfusion. The mean of blood transfusion was 1.5 (2.7) units. The mean of operative length was 286.23 (63.3) minutes and the mean hospital stay was 15.8 (8.1) days. Liver function tests are same with the others authors at day 1, 4 and 7 after operation with return to normal value after 1 week.
Conclusion:
In major liver resection, vascular clamping is not always necessary.
Insights
Major liver resections can be performed without vascular clamping, showing low mortality (3.5%) and morbidity (11.2%). This approach avoids unnecessary risks associated with vascular clamping during liver surgery.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Major liver resection is a complex procedure with potential for significant mortality and morbidity.
- Vascular clamping during liver resection is a technique used to control bleeding but may increase complications.
- Recent reports indicate high morbidity rates (up to 47%) associated with vascular clamping in liver resections.
Purpose of the Study:
- To investigate whether vascular clamping aggravates mortality and morbidity in major liver resections.
- To evaluate the outcomes of major liver resections performed without vascular clamping.
- To determine the necessity of vascular clamping in liver surgery.
Main Methods:
- Retrospective review of 84 major liver resections performed without vascular clamping between 1986 and 1996.
- Analysis of patient demographics, indications for resection, surgical techniques, and outcomes.
- Procedures included right hepatectomy, extended right hepatectomy, left hepatectomy, and middle hepatectomy, utilizing ultrasonic dissection and intraoperative ultrasonography.
Main Results:
- Mortality rate was 3.5% (3 deaths) in the cohort undergoing resection without vascular clamping.
- Major complication rate was 11.2%.
- 54.8% of patients did not require blood transfusion, with a mean transfusion volume of 1.5 units. Operative time averaged 286 minutes, and hospital stay was 15.8 days. Postoperative liver function tests returned to normal within one week.
Conclusions:
- Major liver resections can be safely performed without the use of vascular clamping.
- Vascular clamping is not always a necessary component of major liver resection.
- The study suggests an alternative approach to liver surgery with potentially reduced morbidity.