Vascular Control during Hepatectomy: Review of Methods and Results
- 12 October 2005
- journal article
- review article
- Published by Wiley in World Journal of Surgery
- Vol. 29 (11), 1384-1396
- https://doi.org/10.1007/s00268-005-0025-x
Abstract
The various techniques of hepatic vascular control are presented, focusing on the indications and drawbacks of each. Retrospective and prospective clinical studies highlight aspects of the pathophysiology, indications, and morbidity of the various techniques of hepatic vascular control. Newer perspectives on the field emerge from the introduction of ischemic preconditioning and laparoscopic hepatectomy. A literature review based on computer searches in Index Medicus and PubMed focuses mainly on prospective studies comparing techniques and large retrospective ones. All methods of hepatic vascular control can be applied with minimal mortality by experienced surgeons and are effective for controlling bleeding. The Pringle maneuver is the oldest and simplest of these methods and is still favored by many surgeons. Intermittent application of the Pringle maneuver and hemihepatic occlusion or inflow occlusion with extraparenchymal control of major hepatic veins is particularly indicated for patients with abnormal parenchyma. Total hepatic vascular exclusion is associated with considerable morbidity and hemodynamic intolerance in 10% to 20% of patients. It is absolutely indicated only when extensive reconstruction of the inferior vena cava (IVC) is warranted. Major hepatic veins/ and limited IVC reconstruction has been also achieved under inflow occlusion with extraparenchymal control of major hepatic veins or even using the intermittent Pringle maneuver. Ischemic preconditioning is strongly recommended for patients younger than 60 years and those with steatotic livers. Each hepatic vascular control technique has its place in liver surgery, depending on tumor location, underlying liver disease, patient cardiovascular status, and, most important, the experience of the surgical and anesthesia team.Keywords
This publication has 95 references indexed in Scilit:
- Laparoscopic Liver Resections: A Feasibility Study in 30 PatientsAnnals of Surgery, 2000
- Reduction of transfusion requirements during major hepatic resection for metastatic diseaseSurgery, 1999
- Central venous pressure and its effect on blood loss during liver resectionBritish Journal of Surgery, 1998
- Effects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liverBritish Journal of Surgery, 1996
- Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomyBritish Journal of Surgery, 1995
- Liver resection without blood transfusionBritish Journal of Surgery, 1995
- Perioperative Predictors of Morbidity Following Hepatic Resection for Neoplasm A Multivariate Analysis of a Single Surgeon Experience with 105 PatientsAnnals of Surgery, 1994
- Perioperative Blood Transfusion and Determinants of Survival After Liver Resection for Metastatic Colorectal CarcinomaAnnals of Surgery, 1992
- Prolonged intermittent clamping of the portal triad during hepatectomyBritish Journal of Surgery, 1991
- Can hepatic failure after surgery for hepatocellular carcinoma in cirrhotic patients be prevented?World Journal of Surgery, 1990