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Hepatic Pedicle Occlusion with the Pringle Maneuver During Difficult Laparoscopic Cholecystectomy Reduces the Conversion Rate

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Abstract

Background

In the presence of cholecystitis or portal hypertension, hemorrhage is common during laparoscopic cholecystectomy (LC) because the vessels of Calot’s triangle are fragile and tortuous. Bleeding can obstruct surgical field visibility and increase conversion rates and risk of common bile duct injury. The Pringle maneuver is a simple occlusion approach that could limit blood flow from the hepatic pedicle, thus controlling bleeding to provide a clear surgical field to reduce conversion rate. In this study, we aimed to investigate the feasibility, effectiveness and safety of hepatic pedicle occlusion with the Pringle maneuver during difficult LC.

Methods

From 2011 to 2015, LC with hepatic pedicle occlusion by the Pringle maneuver was performed in 67 patients (Pringle group). Another group of 67 cases with matched clinical parameters where LC was performed without the Pringle maneuver (non-Pringle group) was retrieved from a database to serve as the control group.

Results

The Pringle group had a significantly lower conversion rate (1.49% vs. 11.9%; P = 0.038), less blood loss (37.5 ± 24.1 mL vs. 94.5 ± 67.8 mL; P = 0.002), shorter postoperative hospitalization (2.5 ± 1.4 days vs. 3.5 ± 2.5 days; P = 0.005), and lower cost ($1343 ± $751 USD vs. $1674 ± $609 USD; P = 0.024) than non-Pringle group. There was one case each of bile duct injury and readmission within 30 days because of bile leakage in the non-Pringle group, but none in the Pringle group.

Conclusions

Hepatic pedicle occlusion could provide a clear surgical field and enable the recognition of structures during LC. The Pringle maneuver offers a feasible and safe approach to lower conversion rates in difficult LC.

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Acknowledgements

This work was supported by grants from the National Natural Science Foundation of China (No. 81602910) and the Fundamental Research Fund for the Central Universities (No. 2017SCU11045).

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Author notes

  1. Rongce Zhao and Fei Liu have contributed equally to this work.

Authors and Affiliations

  1. Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan Province, China

    Rongce Zhao, Fei Liu, Chenyang Jia, Kefei Chen, Yonggang Wei & Bo Li

  2. Department of General Surgery, Chengdu First People’s Hospital, Chengdu, China

    Junhua Chen

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  1. Rongce Zhao
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  2. Fei Liu
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  3. Chenyang Jia
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  4. Kefei Chen
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  5. Yonggang Wei
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  6. Junhua Chen
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  7. Bo Li
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Contributions

YGW, BL, and RCZ contributed to the design of this study; RCZ, KFC, and CYJ contributed to the data collection; FL, KFC, JHC, and RCZ contributed to the data analysis; FL and RCZ contributed to writing the text; BL and YGW contributed to the revision of this article.

Corresponding authors

Correspondence to Yonggang Wei or Bo Li.

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All authors declare that they have no conflict of interest.

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Zhao, R., Liu, F., Jia, C. et al. Hepatic Pedicle Occlusion with the Pringle Maneuver During Difficult Laparoscopic Cholecystectomy Reduces the Conversion Rate. World J Surg 43, 207–213 (2019). https://doi.org/10.1007/s00268-018-4770-z

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  • DOI: https://doi.org/10.1007/s00268-018-4770-z

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