Outcomes of Hepatic Resection Using Intermittent Hepatic Vascular Inflow Occlusion with Low Central Venous Pressure.
- Author:
Sang Yeup LEE
1
;
Koo Jeong KANG
;
Yong Hoon KIM
;
Tae Jin LIM
;
Jae Seok HWANG
;
Jung Hyuk KWON
;
Jin Mo KIM
Author Information
1. Department of Surgery, Keimyung University School of Medicine, Daegu, Korea. kjkang@dsmc.or.kr
- Publication Type:Original Article
- Keywords:
Hepatectomy/methods;
Ligation;
Postoperative Complications/prevention & control;
Central Venous Pressure
- MeSH:
Blood Transfusion;
Central Venous Pressure*;
Hemorrhage;
Hepatic Veins;
Hospital Mortality;
Humans;
Kidney;
Ligation;
Liver;
Liver Failure;
Mortality;
Postoperative Complications
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2004;8(2):98-104
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Blood loss and transfusions during a liver resection are associated with higher morbidity and mortality rates. With applying hepatic vascular inflow occlusion (Pringle maneuver), persistent bleeding during a hepatic transection is caused by back flow from the hepatic veins. Therefore, low central venous pressure facilitates to reduce-bleeding from the hepatic veins by lowering the back flow pressure gradient. An intermittent hepatic vascular inflow occlusion was applied, with a lowering of the central venous pressure, during a hepatic resection in our series of patient. The effect of these maneuvers in reducing bleeding and the postoperative complication rates were analyzed. METHODS: Between December 2000 and September 2003, in 153 hepatic resection patients, where this technique was used, the intermittent vascular inflow occlusion and maintenance of the central venous pressure as low as possible were accrued in this study. The overall outcomes of patients that had a hepatic resection, focusing on the amount of bleeding, blood product transfusion and complication rates, were analyzed. RESULTS: The median blood loss was 652.5 ml, and 111 patients (72.5%) required no perioperative blood transfusion. The median units of blood required in the patients who needed a transfusion were 2.3 U. There was no evidence of renal derangement related with low blood flow into the kidney by keeping central venous pressure as low as possible. There were minor complications in 34 patients (22.4%) and two in-hospital mortalities (1.3%) associated with hepatic failure in cirrhotics. CONCLUSION: A hepatic resection, with an intermittent Pringle maneuver and a low central venous pressure, is a very simple and effective modality to reduce bleeding during a hepatic transection, with low morbidity and mortality rates and without hepatic and renal dysfunctions.
