Major liver resections without vascular clamping: retrospective study of 84 cases.
OBJECTIVE
The question as to whether vascular clamping aggravates mortality and morbidity of major liver resection was investigated in this study. Major liver resection with vascular clamping for parenchyma transection has mortality between 0 and 5%, and higher morbidity reaching 47% with healthy liver in recent report.


METHODS
Eighty-four major liver resection without vascular clamping were carried out between January 1986 to December 1996 were reviewed. There were 57 men and 27 women with average age of 58.2 (12.2) years old. Indications of resection were adenoma (4.8%) angioma (11.9%) focal nodular hyperplasia (1.2%) hematoma (1.2%) metastases (60.7%) hepatocellular carcinoma (14.3%) and cholangiocarcinoma (5.9%). Resections used ultrasonic dissector (Sonoca) with intraoperative ultrasonography were right hepatectomy in 56 cases extended right hepatectomy in 10 cases left hepatectomy in 17 cases and middle hepatectomy in 1 case. Remnant liver was cirrhotic in 3 cases.


RESULTS
Three patients died (3.5%) and the rate of major complications were 11.2%. 46 patients (54.8%) had no blood transfusion. The mean of blood transfusion was 1.5 (2.7) units. The mean of operative length was 286.23 (63.3) minutes and the mean hospital stay was 15.8 (8.1) days. Liver function tests are same with the others authors at day 1, 4 and 7 after operation with return to normal value after 1 week.


CONCLUSIONS
In major liver resection, vascular clamping is not always necessary.
Descottes
B
B
Department of Digestive Surgery and Transplantation, Dupuytren University Hospital, Limoges, France.
Thognon
P
P
Valleix
D
D
Mendler
M H
MH
D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003250:Constriction; D005260:Female; D006488:Hemostasis, Surgical; D006498:Hepatectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors