Comparison of controlled and Glisson's pedicle transections of hepatic hilum occlusion for hepatic resection.
BACKGROUND
For hepatic resection, intraoperative bleeding is reduced by clamping the afferent blood flow. Selective clamping at the hepatic hilum can be accomplished using the standard controlled method or Glisson's pedicle transection method. The safety and efficacy of these two methods have not previously been compared.


METHODS
The intraoperative findings and complications were retrospectively reviewed in 90 patients who underwent major hepatectomy with selective inflow clamping between 1988 and 1997.


RESULTS
Blood loss and operative time did not differ between the two groups. Bile leakage was observed in 3 of 43 patients (7.0%) in the standard controlled method group and 11 of 47 patients (23.4%) in the Glisson's pedicle transection method group (p = 0.031). In the Glisson's pedicle transection method group, bile leakage occurred more frequently in patients who underwent left lobectomy than in those who underwent right lobectomy (p = 0.023).


CONCLUSIONS
There were no differences in intraoperative findings and postoperative complications analyzed between the standard controlled method and Glisson's pedicle transection method for major hepatectomy except for the rate of bile leakage. In particular, attention must be paid to the bile duct injuries when the Glisson's pedicle is dissected.
Nakai
T
T
First Department of Surgery, Kinki University School of Medicine, Osaka-sayama, Osaka, Japan.
Koh
K
K
Funai
S
S
Kawabe
T
T
Okuno
K
K
Yasutomi
M
M
D001646:Bile / Q000378:metabolism; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation; D008099:Liver / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies