Comparison of continuous versus intermittent hepatic pedicle clamping in an experimental model.
OBJECTIVE
The tolerance of the liver to ischemia obtained with intermittent clamping of the hepatic pedicle or continuous Pringle maneuver was tested.


METHODS
Ninety rats were divided into three groups undergoing total duration of clamping ischemia of 60, 90, and 120 min. Each group of rats were subdivided to receive continuous Pringle maneuver, 30-min or 15-min intermittent clamping. The clamp release time between the periods of liver ischemia was 5 min. Survival at 7 days and postoperative changes of liver function (transaminase enzymes, bilirubin, and adenosine-5'-triphosphate levels (hepatocellular damage index) were recorded.


RESULTS
Intermittent clamping of the hepatic pedicle was better tolerated than the continuous clamping method. With continuous clamping the rat survival rates inversely correlated with the duration of ischemia. Survival rates at 15-min and 30-min intermittent ischemia groups were significantly higher than in the continuous clamping group.


CONCLUSIONS
This data suggest that when the Pringle maneuver is adopted, it should be applied intermittently rather than continuously.
Chiappa
A
A
University of Milan, European Institute of Oncology, V. Ripamonti, 435, 20141 Milano, Italy. antonio.chiappa@unimi.it
Makuuchi
M
M
Zbar
A P
AP
Biella
F
F
Vezzoni
A
A
Pozzi
S
S
Andreoni
B
B
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D007511:Ischemia / Q000473:pathology; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D051381:Rats; D017208:Rats, Wistar