TY - JOUR
T1 - Extraparenchymal control of hepatic veins during mesohepatectomy
AU - Giuliante, Felice
AU - Nuzzo, Gennaro
AU - Ardito, Francesco
AU - Vellone, Maria
AU - De Cosmo, Germano
AU - Giovannini, Ivo
PY - 2008
Y1 - 2008
N2 - BACKGROUND: Bleeding is the most relevant operative risk during mesohepatectomy because of the wideness of the resection surfaces and the exposure of main intrahepatic vascular structures. Preliminary extraparenchymal exposure of the main hepatic veins, with the possibility of clamping them in association with the Pringle maneuver, and the maintenance of a low central venous pressure during mesohepatectomy, can contribute to substantially reducing operative bleeding.
STUDY DESIGN: We report the results obtained in 18 mesohepatectomies, performed for liver metastases (13 patients) and for hepatocellular carcinoma (5 patients). Liver resection was performed without preliminary exposure of the main hepatic veins in nine patients (group A) and with preliminary looping of the main hepatic veins in nine patients (group B), without complications related to the maneuver.
RESULTS: Intermittent pedicle clamping was used in all patients; in six patients in group B (66.7%), clamping of the main hepatic veins was also performed (mean duration, 37 minutes; range 16 to 68 minutes). Intraciperative blood transfusions were needed in 5 patients (5 of 18, 27.8%): 4 belonged to group A (44.4%) and 1 to group B (11.1%). Mortality was nil and morbidity was 33.3%, involving four patients in group A and two in group B (none related to the exposure, looping, and clamping of the main hepatic veins).
CONCLUSIONS: Preliminary control of the main hepatic veins is a safe maneuver. During mesohepatectomy, clamping of these veins, associated with pedicle clamping, is effective in reducing operative bleeding. In our patients, this resulted in a low blood transfusion rate, similar to that of classic major hepatectomies, despite the higher complexity of mesohepatectomy
AB - BACKGROUND: Bleeding is the most relevant operative risk during mesohepatectomy because of the wideness of the resection surfaces and the exposure of main intrahepatic vascular structures. Preliminary extraparenchymal exposure of the main hepatic veins, with the possibility of clamping them in association with the Pringle maneuver, and the maintenance of a low central venous pressure during mesohepatectomy, can contribute to substantially reducing operative bleeding.
STUDY DESIGN: We report the results obtained in 18 mesohepatectomies, performed for liver metastases (13 patients) and for hepatocellular carcinoma (5 patients). Liver resection was performed without preliminary exposure of the main hepatic veins in nine patients (group A) and with preliminary looping of the main hepatic veins in nine patients (group B), without complications related to the maneuver.
RESULTS: Intermittent pedicle clamping was used in all patients; in six patients in group B (66.7%), clamping of the main hepatic veins was also performed (mean duration, 37 minutes; range 16 to 68 minutes). Intraciperative blood transfusions were needed in 5 patients (5 of 18, 27.8%): 4 belonged to group A (44.4%) and 1 to group B (11.1%). Mortality was nil and morbidity was 33.3%, involving four patients in group A and two in group B (none related to the exposure, looping, and clamping of the main hepatic veins).
CONCLUSIONS: Preliminary control of the main hepatic veins is a safe maneuver. During mesohepatectomy, clamping of these veins, associated with pedicle clamping, is effective in reducing operative bleeding. In our patients, this resulted in a low blood transfusion rate, similar to that of classic major hepatectomies, despite the higher complexity of mesohepatectomy
KW - Intraoperative bleeding
KW - Liver resection
KW - Mesohepatectomy
KW - Normothermic liver ischemia
KW - Pedicle clamping
KW - Preparation of hepatic veins
KW - Preservation of caval flow
KW - Total vascular exclusion
KW - Intraoperative bleeding
KW - Liver resection
KW - Mesohepatectomy
KW - Normothermic liver ischemia
KW - Pedicle clamping
KW - Preparation of hepatic veins
KW - Preservation of caval flow
KW - Total vascular exclusion
UR - http://hdl.handle.net/10807/14322
U2 - 10.1016/j.jamcollsurg.2007.09.019
DO - 10.1016/j.jamcollsurg.2007.09.019
M3 - Article
SN - 1072-7515
VL - 206
SP - 496
EP - 502
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
ER -