title: Cirrhotic livers can tolerate 30 minutes ischaemia at normal environmental temperature.
abstract: OBJECTIVE
  To find out the safe time limit for Pringle's manoeuvre (compression of the hepatic artery and portal vein in the gastrohepatic omentum to halt bleeding) under normal environmental conditions for limited resection of cirrhotic livers.
  
  
  METHODS
  Prospective open study.
  
  
  METHODS
  University hospital, Japan.
  
  
  METHODS
  Pringle's manoeuvre was used in 73 consecutive patients with hepatocellular carcinoma and cirrhosis (Child's classification: A = 44, B = 24, and C = 5), and in 20 patients it was not used (Child's classification: A = 11, B = 5, and C = 4).
  
  
  METHODS
  Limited hepatic resections were done with the duration of Pringle's manoeuvre ranging from 5 to 41 minutes. 15 patients simultaneously underwent 17 other abdominal operations.
  
  
  METHODS
  Child's classification, blood loss during operation, and duration of hepatic ischaemia.
  
  
  RESULTS
  The morbidity and mortality with Pringle's manoeuvre were 1 (2%) and 0 in Child's A cirrhosis, 7 (29%) and 2 (8%) in Child's B cirrhosis, and 2 (40%) and 1 (20%) in Child's C cirrhosis. The higher rates in class B and C patients were ascribed to the amount of blood loss rather than to Pringle's manoeuvre.
  
  
  CONCLUSIONS
  Pringle's manoeuvre can be used safely for up to 30 minutes during limited resection of the cirrhotic liver.
authors.affiliation: Second Department of Surgery, Shimane Medical University, Izumo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Nagasue
authors.forename: M
authors.initials: M
authors.lastname: Uchida
authors.forename: H
authors.initials: H
authors.lastname: Kubota
authors.forename: T
authors.initials: T
authors.lastname: Hayashi
authors.forename: H
authors.initials: H
authors.lastname: Kohno
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D003250:Constriction; D004777:Environment; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006499:Hepatic Artery; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000145:classification / Q000503:physiopathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011169:Portal Vein; D011183:Postoperative Complications; D011446:Prospective Studies; D013696:Temperature; D013997:Time Factors; D016896:Treatment Outcome