Safety of selective vascular clamping for major hepatectomies.
BACKGROUND
Although hepatic vascular clampings are widely used during major hepatic resections, they may not always be necessary. Selective vascular clamping, which only controls the afferent blood flow of the resected liver, could be a valuable alternative, provided that blood loss is not increased because the opposite liver remains perfused.


METHODS
The aim of the study was to assess the safety of selective vascular clamping in 43 patients who underwent 36 right hepatectomies and 7 left hepatectomies for lesions located peripherally within the liver. Blood transfusions, hepatic tests, morbidity, mortality, and hospital stay were evaluated.


RESULTS
Selective vascular clamping was efficient in 34 of the 43 attempts (79%), but bleeding from the contralateral liver required conversion to portal triad damping in 9 patients (21%). Median blood transfusions were 0 units (range 0 to 4 U), and 28 patients (65%) did not require transfusions. Postoperative laboratory tests showed that larger changes occurred at day 1 and tended to return to preoperative values at the end of the first postoperative week. Median time of hospitalization was 10 days (range 7 to 28 days). Postoperative course was uneventful in 35 patients (81%). Nonlethal complications occurred in 7 patients (16.3%). One patient (2%) with massive hepatic steatosis died of liver failure after right hepatectomy.


CONCLUSIONS
Selective vascular clamping is a safe alternative to total inflow occlusion for major hepatectomies applicable in 80% of selected patients with peripheral liver tumors.
Malassagne
B
B
Department of Digestive Surgery, Hôpital Henri Mondor-Université Paris XII, Créteil, France.
Cherqui
D
D
Alon
R
R
Brunetti
F
F
Humeres
R
R
Fagniez
P L
PL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D003250:Constriction; D005069:Evaluation Studies as Topic; D005234:Fatty Liver / Q000601:surgery; D006498:Hepatectomy / Q000009:adverse effects / Q000145:classification / Q000379:methods*; D006503:Hepatic Veins / Q000473:pathology*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008102:Liver Circulation; D017093:Liver Failure / Q000209:etiology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D012449:Safety; D015996:Survival Rate; D013997:Time Factors