Selective and unselective clamping in cirrhotic liver

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Transplant Surgery

Background:

• Liver surgery, particularly hepatic resection, necessitates minimizing operative blood loss, especially in patients with cirrhosis.
• Vascular clamping techniques, including total hilar clamping (Pringle's manoeuvre) and selective vascular clamping (Makuuchi's manoeuvre), are employed to reduce surgical risks in compromised patients.

Purpose of the Study:

• To evaluate the clinical outcomes of elective hepatic resection using Pringle's manoeuvre versus Makuuchi's manoeuvre.
• To assess the safety and efficacy of these clamping techniques in patients with varying degrees of liver function, including cirrhosis.

Main Methods:

• A retrospective analysis of 158 patients undergoing elective hepatic resection.
• Comparison of outcomes between patients treated with total hilar clamping (Pringle's manoeuvre) and selective vascular clamping (Makuuchi's manoeuvre).
• Evaluation of operative blood loss, clamping times, and post-operative recovery based on clamping method and liver condition.

Main Results:

• Pringle's manoeuvre was used in 132 patients, and Makuuchi's manoeuvre in 26 patients, with modified Makuuchi's in 8 healthy donors.
• Mean operative blood loss was 831 ml for Pringle's and 1,035 ml for Makuuchi's manoeuvre.
• All patients tolerated clamping well, with hepatic function returning to baseline within a week, irrespective of cirrhosis. Operative morbidity was 20.3% and mortality was 0%.

Conclusions:

• Intermittent total or selective vascular clamping is essential for safe and effective hepatic resection in all patients.
• These procedures improve resectability and safety, regardless of the patient's hepatic functional status.
• Vascular clamping techniques are indispensable tools in managing liver resections, even in patients with compromised liver function.