Skip to main content
SpringerLink
Log in

Effect of Infra-Hepatic Inferior Vena Cava Clamping on Bleeding During Hepatic Dissection: A Prospective, Randomized, Controlled Study

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The success of hepatectomy can be associated with intraoperative blood loss because massive blood loss causes a poor prognosis. This study was designed to evaluate the effect of infrahepatic inferior vena cava (IVC) clamping on the bleeding amount during hepatectomy.

Methods

Eighty-five patients scheduled to undergo hepatic resection were randomly assigned to the IVC clamping or an IVC nonclamping group according to age, indocyanine green retention rate at 15 minutes, operative procedure, and number of tumors by prospective, randomized method. All analyses were compared by Mann-Whitney U test.

Results

Forty-three patients were assigned to the IVC clamping group and 42 to the nonclamping group (IVC clamping group vs. non-clamping): total blood loss (499 vs. 584 ml; p = 0.567), amount of bleeding during hepatectomy (233 vs. 285 ml; p = 0.474), amount of bleeding during hepatectomy/area of dissection (4.9 vs. 6.6 ml/cm2; p = 0.63), CVP difference (−3 cmH2O vs. −1 cmH2O; p < 0.01), and diameter of the right hepatic vein (−2.2 cm vs. 0; p < 0.01).

Conclusions

Although we had speculated that infrahepatic IVC clamping would reduce blood loss during hepatectomy, we failed to demonstrate any beneficial effects in this clinical setting with low CVP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yanaga K, Kanematsu T, Takenaka K et al (1988) Hepatic resection for hepatocellular carcinoma in elderly patients. Am J Surg 155:238–241

    Article  PubMed  CAS  Google Scholar 

  2. Nagao T, Goto S, Kawano N et al (1986) Hepatic resection for hepatocellular carcinoma. Ann Surg 205:33–40

    Article  Google Scholar 

  3. Man K, Fan ST, Ng IOL et al (1997) Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg 226:704–713

    Article  PubMed  CAS  Google Scholar 

  4. Jones RM, Moulton CE, Hardy KJ (1998) Central venous pressure and its effect on blood loss during liver resection. Br J Surg 85:1058–1060

    Article  PubMed  CAS  Google Scholar 

  5. Johnson M, Mannar R, Wu AVO (1998) Correlation between blood loss and inferior vena caval pressure during liver resection. Br J Surg 85:188–190

    Article  PubMed  CAS  Google Scholar 

  6. Makuuchi M, Kosuge T, Takayama T et al (1993) Surgery for small liver cancers. Semin Surg Oncol 9:298–304

    Article  PubMed  CAS  Google Scholar 

  7. Melendez JA, Arslan V, Fischer ME et al (1998) Perioerative 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

    Article  PubMed  CAS  Google Scholar 

  8. Grossman M, Aboise A, Tangphao O et al (1996) Morphine-induced venodilation in humans. Clin Pharmacol Ther 60:554–560

    Article  Google Scholar 

  9. Rees M, Plant G, Wells J, Bygrave S (1996) One hundred and fifty hepatic resections: evolution of technique towards bloodless surgery. Br J Surg 83:1526–1529

    Article  PubMed  CAS  Google Scholar 

  10. Hasegawa K, Takayama T, Orii R et al (2002) Effect of hypoventilation on bleeding during hepatic resection. Arch Surg 137:311–315

    Article  PubMed  Google Scholar 

  11. Bismuth H, Castaing D, Garden J (1989) Major hepatic resection under total vascular exclusion. Ann Surg 210:13–19

    Article  PubMed  CAS  Google Scholar 

  12. Huguet C, Addario-Chieco P, Gavelli A et al (1992) Technique of hepatic vascular exclusion for extensive liver resection. Am J Surg 163:602–605

    Article  PubMed  CAS  Google Scholar 

  13. Belghiti J, Noun R, Zante E, Ballet T, Sauvanet A (1996) Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study. Ann Surg 224:155–161

    Article  PubMed  CAS  Google Scholar 

  14. Ellias D, Lasser P, Dabaene B et al (1995) Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy. Br J Surg 82:1535–1539

    Article  Google Scholar 

  15. Cherqui D, Malassagne B, Colau PI et al (1999) Hepatic vascular exclusion with preservation of the caval flow for liver resection. Ann Surg 230:24–30

    Article  PubMed  CAS  Google Scholar 

  16. Otsubo T, Takahashi K, Yamamoto M et al (2004) Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery 135:67–73

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, Japan

    Masato Kato, Keiichi Kubota, Junji Kita, Mitsugi Shimoda, Kyu Rokkaku & Tokihiko Sawada

Authors
  1. Masato Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keiichi Kubota
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junji Kita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mitsugi Shimoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyu Rokkaku
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tokihiko Sawada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masato Kato.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kato, M., Kubota, K., Kita, J. et al. Effect of Infra-Hepatic Inferior Vena Cava Clamping on Bleeding During Hepatic Dissection: A Prospective, Randomized, Controlled Study. World J Surg 32, 1082–1087 (2008). https://doi.org/10.1007/s00268-007-9445-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-007-9445-0

Keywords

Search

Navigation