Hepatic resection with vascular isolation and routine supraceliac aortic clamping.
BACKGROUND
Hepatic resection with total vascular isolation has been reported to reduce hemorrhage. Addition of supraceliac aortic clamping putatively avoids hemodynamic instability, but may increase morbidity.


METHODS
This technique was used in 99 major liver resections utilizing scalpel division and suture hemostasis.


RESULTS
Livers were normal in 86 patients, cirrhotic with no portal hypertension in 5, and cirrhotic with portal hypertension in 8. There was 1 death in 91 patients with no portal hypertension due to hepatic failure or bleeding esophageal varices. There were 59 hemihepatectomies and 40 segmentectomies. Median operating time was 145 and 110 minutes, respectively, and mean transfused blood was 4 and 0 units, respectively, with minimal morbidity.


CONCLUSIONS
Use of total hepatic vascular isolation with routine supraceliac aortic clamping is a safe and expedient method of hepatic resection that limits blood loss and maintains hemodynamic stability, but does not increase morbidity. However, the presence of portal hypertension precludes safe resection.
Stephen
M S
MS
Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
Gallagher
P J
PJ
Sheil
A G
AG
Sheldon
D M
DM
Storey
D W
DW
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged