World Journal of Surgery

, Volume 42, Issue 10, pp 3302–3311 | Cite as

Does Intermittent Pringle Maneuver Increase Postoperative Complications After Hepatectomy for Hepatocellular Carcinoma? A Randomized Controlled Trial

  • Kit Fai LeeEmail author
  • John Wong
  • Sunny Y. S. Cheung
  • Charing C. N. Chong
  • Joyce W. Y. Hui
  • Vivian Y. F. Leung
  • Simon C. H. Yu
  • Paul B. S. Lai
Original Scientific Report



In a previous study, we have shown that intermittent Pringle maneuver (IPM) might increase postoperative complications after hepatectomy for various indications. Complications which thought to be related to IPM were ascites, pleural effusion, wound infection and intra-abdominal collection. The aim of this study was to test the hypothesis that applying IPM during hepatectomy for hepatocellular carcinoma (HCC) could increase postoperative complications.


Between January 2013 and October 2016, eligible patients who received elective open hepatectomy for HCC were randomized to have IPM or no Pringle maneuver (NPM). Occurrence of various types of postoperative complications was specifically looked for. A routine postoperative day 5 abdominal ultrasound examination and chest X-ray were done to detect and grade any radiological ascites, pleural effusion and intra-abdominal collection.


Fifty IPM and 50 NPM patients with histological proven HCC were recruited for final analysis. Demographics and operative parameters were comparable between the two groups. The postoperative complication rates were similar (IPM 36.0 vs. NPM 28.0%, P = 0.391). However, in the IPM group, more patients developed radiological posthepatectomy ascites (42.0 vs. 22.0%, P = 0.032) and pleural effusion (66.0 vs. 38.0%, P = 0.005). In patients with histologically proven cirrhosis, there were 28 IPM and 25 NPM patients. Again, there was no difference in postoperative complication rate but more radiological posthepatectomy ascites and pleural effusion in the IPM group.


This trial was not able to detect a difference in postoperative complications whether IPM was applied or not, but use of IPM was associated with more subclinical ascites and pleural effusion. ( NCT01759901).

Trial registration number NCT01759901.



The authors thank Mr. Philip Ip for his assistance with data processing and statistical analysis, and thank Dr. Anthony Fong, Dr. Andrew Fung and Dr. Hon-ting Lok for providing surgical care on the study patents.

Compliance with ethical standards

Conflicts of interest

All the authors have no conflicts of interest or financial ties to disclose


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Kit Fai Lee
    • 1
    Email author
  • John Wong
    • 1
  • Sunny Y. S. Cheung
    • 1
  • Charing C. N. Chong
    • 1
  • Joyce W. Y. Hui
    • 2
  • Vivian Y. F. Leung
    • 2
  • Simon C. H. Yu
    • 2
  • Paul B. S. Lai
    • 1
  1. 1.Department of Surgery, Prince of Wales HospitalThe Chinese University of Hong KongShatin, N.T.China
  2. 2.Department of Imaging and Interventional Radiology, Prince of Wales HospitalThe Chinese University of Hong KongShatin, N.T.China

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