Vascular occlusion techniques for liver resections

Prevention of intraoperative blood loss during liver resection is of prime concern. Intraoperative blood loss has indeed repeatedly been shown to adversely influence the short-term prognosis of patients undergoing liver resection. There is in addition evidence that it could be associated with an increased risk; of recurrence in patients operated for an hepato-biliary malignancy through impairment of the patient's immune response. The prime concern of the hepato-biliary surgeon is to minimize blood loss through the control of the major vascular structures this may be achieved in several ways that range from segmental portal control to total hepatic vascular occlusion. The type of vascular occlusion should be selected according to the indication and in particular location of the tumour and presence of an associated underlying liver disease, the patient's cardiovascular status and the experience of the operator. Aim of the authors is to describe the various types of vascular control as well as their benefits and drawbacks so as to use the most appropriate technique according, to each patient' requirements.