title: Total vascular exclusion of the liver during hepatic surgery. Selective use, extensive use, or abuse?
abstract: OBJECTIVE
  To review our experience with total vascular exclusion of the liver and to assess its role in hepatic resections.
  
  
  METHODS
  Retrospective survey.
  
  
  METHODS
  University hospital, a tertiary referring center for surgical liver diseases.
  
  
  METHODS
  A total of 722 patients who underwent liver resections from November 1, 1981, to March 31, 1996, of whom 19 (2.6%) required total vascular exclusion because of hepatic lesions closely adherent to or infiltrating the retrohepatic vena cava or centrally located in the liver, strictly in contact with the hepatic vein convergence.
  
  
  METHODS
  chi 2 Test for qualitative data and Student t test for categorical data.
  
  
  RESULTS
  Of the 19 resections carried out under total vascular exclusion, 6 had tumoral infiltration of the retrohepatic vena cava: in 4 cases the venous wall was partially resected, while in the remaining 2 it was completely removed and replaced with a prosthetic graft. There were no operative deaths. Of the 722 resections, 227 were major hepatectomies: 74 (32.6%) were performed after ligation of the glissonian elements for the hemiliver to be removed, without clamping of the hepatic pedicle, and a further 36 (15.8%) were performed without any preliminary vascular control. A significant reduction in intraoperative blood transfusions was achieved despite the performance of more extended operations, regardless of the technique used.
  
  
  CONCLUSIONS
  Total vascular exclusion is a useful tool in controlling blood inflow to the liver, but true need for it during liver resection is limited. Its performance requires a well-trained team familiar with problems regarding surgical access to the inferior vena cava and prolonged occlusion of the hepatic pedicle and the inferior vena cava.
authors.affiliation: Second Department of Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Italy.
authors.forename: G L
authors.initials: GL
authors.lastname: Grazi
authors.forename: A
authors.initials: A
authors.lastname: Mazziotti
authors.forename: E
authors.initials: E
authors.lastname: Jovine
authors.forename: F
authors.initials: F
authors.lastname: Pierangeli
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.forename: A
authors.initials: A
authors.lastname: Gallucci
authors.forename: A
authors.initials: A
authors.lastname: Cavallari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior / Q000601:surgery