Abstract
Selective hepatic vascular exclusion (SHVE) and the Pringle maneuver are two methods used to control bleeding during hepatectomy. They are compared in a prospective randomized study, where 110 patients undergoing major liver resection were randomly allocated to the SHVE group or the Pringle group. Data regarding the intraoperative and postoperative courses of the patients are analyzed. Intraoperative blood loss and transfusion requirements were significantly decreased in the SHVE group, and postoperative liver function was better in that group. Although there was no difference between the two groups regarding the postoperative complications rate, patients offered the Pringle maneuver had a significantly longer hospital stay. The application of SHVE did not prolong the warm ischemia time or the total operating time. It is evident from the present study that SHVE performed by experienced surgeons is as safe as the Pringle maneuver and is well tolerated by the patients. It is much more effective than the Pringle maneuver for controlling intraoperative bleeding, and it is associated with better postoperative liver function and shorter hospital stay.
Similar content being viewed by others
References
G Gozzetti A Mazziotti GL Grazi et al. (1995) ArticleTitleLiver resection without blood transfusion Br. J. Surg. 82 1105–1110 Occurrence Handle1:STN:280:ByqA2snitFU%3D Occurrence Handle7648166
J Yamamoto T Kosuge T Takayama et al. (1994) ArticleTitlePerioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy Surgery 115 303–309 Occurrence Handle1:STN:280:ByuC2svktFw%3D Occurrence Handle8128355
M Shimada T Matsumata K Akazawa et al. (1994) ArticleTitleEstimation of risk of major complications after hepatic resection Am. J. Surg. 167 399–403 Occurrence Handle1:STN:280:ByuB3svksVM%3D Occurrence Handle8179084
JD Cunningham Y Fong C Shriven et al. (1994) ArticleTitleOne hundred consecutive hepatic resections: blood loss, transfusion and operative technique Arch. Surg. 129 1050–1056 Occurrence Handle1:STN:280:ByqD3s7mtlI%3D Occurrence Handle7944934
T Berney G Mentha P Morel (1998) ArticleTitleTotal vascular exclusion of the liver for the resection of lesions in contact with the vena cava or the hepatic veins Br. J. Surg. 85 485–488 Occurrence Handle10.1046/j.1365-2168.1998.00659.x Occurrence Handle1:STN:280:DyaK1c3mvVGntg%3D%3D Occurrence Handle9607528
M Miyazaki H Ho K Nakagawa et al. (1999) ArticleTitleAggressive surgical resection for hepatic metastases involving the inferior vena cava Am. J. Surg. 177 294–298 Occurrence Handle10.1016/S0002-9610(99)00044-6 Occurrence Handle1:STN:280:DyaK1M3ls1Okug%3D%3D Occurrence Handle10326846
NA Habib NE Michail T Boyle et al. (1994) ArticleTitleResection of the inferior vena cava during hepatectomy for liver tumors Br. J. Surg. 81 1023–1024 Occurrence Handle1:STN:280:ByqD3cnjsVE%3D Occurrence Handle7922053
E Delva Y Camus B Nordlinger et al. (1989) ArticleTitleVascular occlusions for liver resections: operative management and tolerance to hepatic ischemia: 142 cases Ann. Surg. 209 211–218 Occurrence Handle1:STN:280:BiaC3szmtVU%3D Occurrence Handle2916865
C Huguet A Gavelli PA Chieco et al. (1992) ArticleTitleLiver ischemia for hepatic resection: where is the limit? Surgery 111 251–259 Occurrence Handle1:STN:280:By2C2sboslM%3D Occurrence Handle1311871
D Elias E Desruennes P Lasser (1991) ArticleTitleProlonged intermittent clamping of the portal triad during hepatectomy Br. J. Surg. 78 42–44 Occurrence Handle1:STN:280:By6C2M3ktlQ%3D Occurrence Handle1998862
L Hannoun D Borie E Delva et al. (1993) ArticleTitleLiver resection with normothermic ischaemia exceeding 1 h Br. J. Surg. 80 1161–1165 Occurrence Handle1:STN:280:ByuD3crmsVI%3D Occurrence Handle8402122
K Man ST Fan IOL Ng et al. (1997) ArticleTitleProspective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study Ann. Surg. 226 704–713 Occurrence Handle10.1097/00000658-199712000-00007 Occurrence Handle1:STN:280:DyaK1c%2Fnt1ahtQ%3D%3D Occurrence Handle9409569
K Man ST Fan IOL Ng et al. (1999) ArticleTitleTolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors Arch. Surg. 134 533–539 Occurrence Handle10.1001/archsurg.134.5.533 Occurrence Handle1:STN:280:DyaK1M3lsFSjtw%3D%3D Occurrence Handle10323426
J Belghiti R Noun R Malafosse et al. (1999) ArticleTitleContinuous versus intermittent portal triad clamping for liver resection: a controlled study Ann. Surg. 229 369–375 Occurrence Handle10.1097/00000658-199903000-00010 Occurrence Handle1:STN:280:DyaK1M7nsVKltQ%3D%3D Occurrence Handle10077049
CC Wu CR Hwang TJ Liu et al. (1996) ArticleTitleEffects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liver Br. J. Surg. 83 121–124
GL Grazi A Mazzioti E Jovine et al. (1997) ArticleTitleTotal vascular exclusion of the liver during hepatic surgery: selective use, extensive use, or abuse? Arch. Surg. 132 1104–1109 Occurrence Handle1:STN:280:ByiH2sjltVI%3D Occurrence Handle9336509
D Cherqui B Malassagne PI Colau et al. (1999) ArticleTitleHepatic vascular exclusion with preservation of caval flow for liver resections Ann. Surg. 230 24–30 Occurrence Handle10.1097/00000658-199907000-00004 Occurrence Handle1:STN:280:DyaK1MzisFKiuw%3D%3D Occurrence Handle10400032
J Belghiti R Noun E Zante et al. (1996) ArticleTitlePortal triad clamping or hepatic vascular exclusion for major liver resection: a controlled study Ann. Surg. 224 155–161 Occurrence Handle10.1097/00000658-199608000-00007 Occurrence Handle1:STN:280:BymA3srgsFY%3D Occurrence Handle8757378
G Torzilli M Makuuchi Y Midorikawa et al. (2001) ArticleTitleLiver resection without total vascular exclusion: hazardous or beneficial? An analysis of our experience Ann. Surg. 233 167–175 Occurrence Handle10.1097/00000658-200102000-00004 Occurrence Handle1:STN:280:DC%2BD3M7ls1Sntw%3D%3D Occurrence Handle11176121
VE Smyrniotis GG Kostopanagiotou EL Gamaletsos et al. (2002) ArticleTitleTotal versus selective hepatic vascular exclusion in major liver resections Am. J. Surg. 183 173–178 Occurrence Handle10.1016/S0002-9610(01)00864-9 Occurrence Handle11918884
ED Staren M Gambla DJ Deziel et al. (1997) ArticleTitleIntraoperative ultrasound in the management of liver neoplasms Am. Surg. 63 591–597 Occurrence Handle1:STN:280:ByiA2cnhtFY%3D Occurrence Handle9202532
AJ Luck GJ Maddern (1999) ArticleTitleIntraoperative abdominal ultrasonography Br. J. Surg. 86 5–16 Occurrence Handle10.1046/j.1365-2168.1999.00990.x Occurrence Handle1:STN:280:DyaK1M7kvFGquw%3D%3D Occurrence Handle10027353
C Peralta G Hotter D Closa et al. (1997) ArticleTitleProtective effect of preconditioning on the injury associated to hepatic ischemia-reperfusion in the rat: role of nitric oxide and adenosine Hepatology 25 934–937 Occurrence Handle1:CAS:528:DyaK2sXislejtbo%3D Occurrence Handle9096600
ECS Lai ST Fan CM Lo et al. (1996) ArticleTitleAnterior approach for difficult major right hepatectomy World J. Surg. 20 314–318 Occurrence Handle10.1007/s002689900050 Occurrence Handle1:STN:280:BymA38rmtlQ%3D Occurrence Handle8661837
J Yamamoto T Kosuge K Shimada et al. (1999) ArticleTitleAnterior transhepatic approach for isolated resection of the caudate lobe of the liver World J. Surg. 23 97–101 Occurrence Handle10.1007/s002689900572 Occurrence Handle1:STN:280:DyaK1M%2FlvVWhtA%3D%3D Occurrence Handle9841771
Y Hatano M Murakawa H Segawa et al. (1990) ArticleTitleVenous air embolism during hepatic resection Anesthesiology 73 1282–1285 Occurrence Handle1:STN:280:By6D28zmtFU%3D Occurrence Handle2248411
S Emre M Schwartz E Katz et al. (1993) ArticleTitleLiver resection under total vascular isolation: variations on a theme Ann. Surg. 217 15–19 Occurrence Handle1:STN:280:ByyC2czktVc%3D Occurrence Handle8424696
C Huguet P Addario-Chieco A Gavelli et al. (1992) ArticleTitleTechnique of hepatic vascular exclusion for extensive liver resection Am. J. Surg. 163 602–605 Occurrence Handle1:STN:280:By2B1c%2FpvFM%3D Occurrence Handle1595841
Y Yamaoka K Ozawa K Kumada et al. (1992) ArticleTitleTotal vascular exclusion for hepatic resection in cirrhotic patients: application of venovenous bypass Arch. Surg. 127 276–280 Occurrence Handle1:STN:280:By2C1MfhvFA%3D Occurrence Handle1312817
GA Cosmo ParticleDe E Adducci EM Gualtieri (2000) ArticleTitleHaemodynamic and metabolic changes during major liver resection with use of hepatic total vascular exclusion Int. Surg. 85 243–247 Occurrence Handle11325004
D Elias P Lasser B Debaene et al. (1995) ArticleTitleIntermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy Br. J. Surg. 82 1535–1539 Occurrence Handle1:STN:280:BymC3sjps1E%3D Occurrence Handle8535812
B Malassagne D Cherqui R Alon et al. (1998) ArticleTitleSafety of selective vascular clamping for major hepatectomies J. Am. Coll. Surg. 187 482–486 Occurrence Handle10.1016/S1072-7515(98)00234-8 Occurrence Handle1:STN:280:DyaK1M%2FisFCitQ%3D%3D Occurrence Handle9809563
Y Midorikawa K Kubota T Takayama et al. (1999) ArticleTitleA comparative study of postoperative complications after hepatectomy in patients with and without chronic liver disease Surgery 126 484–494 Occurrence Handle10.1067/msy.2099.99573 Occurrence Handle1:STN:280:DyaK1Mvhs1Smtg%3D%3D Occurrence Handle10486600
S Nakamura S Sakaguchi T Kitazawa et al. (1990) ArticleTitleHepatic vein reconstruction for preserving remnant liver function Arch. Surg. 125 1455–1459 Occurrence Handle1:STN:280:By6D2MzntlU%3D Occurrence Handle2241557
S Nakamura S Sakaguchi T Hachiya et al. (1993) ArticleTitleSignificance of hepatic vein reconstruction in hepatectomy Surgery 114 59–64 Occurrence Handle1:STN:280:ByyA283gslM%3D Occurrence Handle8356528
T Takayama T Nakatsuka J Yamamoto et al. (1996) ArticleTitleRe-reconstruction of a single remnant hepatic vein Br. J. Surg. 83 762–763
V Smyrniotis N Arkadopoulos D Kehagias et al. (2002) ArticleTitleLiver resection with repair of major hepatic veins Am. J. Surg. 183 58–61 Occurrence Handle10.1016/S0002-9610(01)00827-3 Occurrence Handle11869704
RMcL Jones CE Moulton KJ Hardy InstitutionalAuthorName. (1998) ArticleTitleCentral venous pressure and its effect on blood loss during liver resection Br. J. Surg. 85 1058–1060 Occurrence Handle10.1046/j.1365-2168.1998.00795.x Occurrence Handle1:STN:280:DyaK1czot1Sqtw%3D%3D Occurrence Handle9717995
JA Melendez V Arslan ME Fischer et al. (1998) ArticleTitlePerioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion and the risk of postoperative renal dysfunction J. Am. Coll. Surg. 187 620–625 Occurrence Handle10.1016/S1072-7515(98)00240-3 Occurrence Handle1:STN:280:DyaK1M%2FmsV2rug%3D%3D Occurrence Handle9849736
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Smyrniotis, V., Kostopanagiotou, G., Contis, J. et al. Selective Hepatic Vascular Exclusion versus Pringle Maneuver in Major Liver Resections: Prospective Study. World J. Surg. 27, 765–769 (2003). https://doi.org/10.1007/s00268-003-6978-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-003-6978-8