Hepatic vascular exclusion for hepatic resection

Abstract

The scope of blood loss and replacement with liver surgery is important in the final results of such surgery. Although intraoperative death from bleeding was once a significant consideration with liver resections, it is now an uncommon cause of death for elective liver operations. Nevertheless, control of blood loss remains an important issue. There is a strong correlation between blood loss in excess of 4–5 liters and postoperative complications and hospital mortality in patients undergoing liver resection [1,2]. Significant intraoperative bleeding obscures the operative field such that accidental injury to biliary structures is more likely to occur and location and control of bleeding vessels are more difficult. Large transfusion requirements frequently result in coagulopathies with additional bleeding. Hypotension and hypoperfusion associated with blood loss have negative physiologic consequences for many organ systems. There is a risk of serious viral infection correlating with the amount of blood products administered. Finally, for patients in whom liver resection is for treatment of malignancy, evidence is mounting that there is an increased rate of recurrence of malignancy when substantial blood transfusions are given in the perioperative period [3,4].