Liver resections can be performed safely without Pringle maneuver: A prospective study
| Autor: | Mikolaj Walensi, Anne Zuse, Christoph A. Maurer, René Lötscher, Beat M. Künzli, Samuel A. Käser |
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| Přispěvatelé: | University of Zurich, Maurer, Christoph A |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Portal triad Cirrhosis Hepatology business.industry General surgery Central venous pressure 610 Medicine & health Perioperative 030230 surgery Liver resections medicine.disease Surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Blood loss 030220 oncology & carcinogenesis medicine Prospective Study 2721 Hepatology Liver damage Prospective cohort study business 10217 Clinic for Visceral and Transplantation Surgery |
| Zdroj: | World journal of hepatology. 8(24) |
| ISSN: | 1948-5182 |
| Popis: | AIM: To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad. METHODS: Between 9/2002 and 7/2013, 175 consecutive liver resections (n = 101 major anatomical and n = 74 large atypical > 5 cm) without Pringle maneuver were performed in 127 patients (143 surgeries). Accompanying, 37 wedge resections (specimens < 5 cm) and 43 radiofrequency ablations were performed. Preoperative volumetric calculation of the liver remnant preceeded all anatomical resections. The liver parenchyma was dissected by water-jet. The median central venous pressure was 4 mmHg (range: 5-14). Data was collected prospectively. RESULTS: The median age of patients was 60 years (range: 16-85). Preoperative chemotherapy was used in 70 cases (49.0%). Liver cirrhosis was present in 6.3%, and liver steatosis of ≥ 10% in 28.0%. Blood loss was median 400 mL (range 50-5000 mL). Perioperative blood transfusions were given in 22/143 procedures (15%). The median weight of anatomically resected liver specimens was 525 g (range: 51-1850 g). One patient died postoperatively. Biliary leakages (n = 5) were treated conservatively. Temporary liver failure occurred in two patients. CONCLUSION: Major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay. |
| Databáze: | OpenAIRE |
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