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Impact of the Prolonged Intermittent Pringle Maneuver on Post-Hepatectomy Liver Failure: Comparison of Open and Laparoscopic Approaches

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Abstract

Background

The influence of prolonged intermittent Pringle maneuver (IPM) on post-hepatectomy liver failure (PHLF) remains unclear. We evaluated the impact of the prolonged IPM on PHLF in patients undergoing open and laparoscopic hepatectomy.

Methods

We retrospectively included 546 patients who underwent hepatectomy using IPM. The patients were divided into open (n = 294) and laparoscopic (n = 252) groups. Odds ratios for PHLF occurrence were estimated in each group according to cumulative Pringle time (CPT). The cut-off value was set at CPT of 120 min. Risk factors for PHLF were evaluated in the open and laparoscopic groups. Additionally, we analyzed the post-operative outcomes in the open and laparoscopic groups with CPT ≥ 120 min and performed propensity score matching analysis based on PFLF-associated factors.

Results

In the open group, the risk of PHLF increased as CPT increased, particularly after 120 min. However, in the laparoscopic group, PHLF did not occur at less than 60 min, and the risk of PHLF was not significantly different at more than 60 min. Multivariate analysis identified CPT ≥ 120 min as an independent risk factor for PHLF in the open group (p < 0.001), but not in the laparoscopic group. Propensity score matching analysis showed that the PHLF rate was significantly lower in the laparoscopic group with CPT ≥ 120 min (p = 0.027). The post-operative transaminase levels were significantly lower in the laparoscopic group with CPT ≥ 120 min.

Conclusions

Laparoscopic hepatectomy may cause less PHLF with prolonged IPM compared with open hepatectomy.

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Acknowledgements

We thank Editage (www.editage.com) for English language editing and Naoki Ozu (Institute of Clinical and Translational Science, Nara Medical University Hospital) for helpful statistical advice.

Funding

Funding information is not applicable.

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Authors and Affiliations

  1. Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan

    Shunsuke Doi, Satoshi Yasuda, Daisuke Hokuto, Naoki Kamitani, Yasuko Matsuo, Takeshi Sakata, Satoshi Nishiwada, Minako Nagai, Kota Nakamura, Taichi Terai, Yuichiro Kohara & Masayuki Sho

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  1. Shunsuke Doi
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  2. Satoshi Yasuda
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  3. Daisuke Hokuto
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Correspondence to Satoshi Yasuda.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The protocol for this study has been approved by a suitable constituted Ethics Committee of the institution and it conforms to the provisions of the Declaration of Helsinki. Local Ethics Committee on Clinical Investigation of Nara Medical University, Approval No.: 3358.

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Doi, S., Yasuda, S., Hokuto, D. et al. Impact of the Prolonged Intermittent Pringle Maneuver on Post-Hepatectomy Liver Failure: Comparison of Open and Laparoscopic Approaches. World J Surg 47, 3328–3337 (2023). https://doi.org/10.1007/s00268-023-07201-3

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