Total versus selective hepatic vascular exclusion in major liver resections.
BACKGROUND
Total hepatic vascular exclusion (THVE) and selective hepatic vascular exclusion (SHVE) are two effective techniques for bleeding control in major hepatic resections. Outcomes of the two procedures were compared.


METHODS
Patients undergoing major liver resection were randomly allocated to the THVE and SHVE groups. Intraoperative hemodynamic changes and the postoperative course of the two groups were compared.


RESULTS
During vascular clamping, the THVE group showed a significant elevation in pulmonary vascular resistance, systemic vascular resistance, intrapulmonary shunts, and a significant reduction in cardiac index, compared with the SHVE group (P <0.05). Patients undergoing THVE received more crystalloids and blood, showed more severe liver, renal and pancreatic dysfunction, and had a longer hospital stay than the SHVE group (P <0.05).


CONCLUSIONS
Both techniques are equally effective in bleeding control in major liver resections. THVE is associated with cardiorespiratory and hemodynamic alterations and may be not tolerated by some patients. SHVE is well tolerated with fewer postoperative complications and shorter hospitalization time.
Smyrniotis
Vassilios E
VE
Department of Surgery, University of Athens Medical School, Aretaeion Hospital, 22 Hanioti St., 154 52 Athens, Greece. vsmyrniotis@hotmail.com
Kostopanagiotou
Georgia G
GG
Gamaletsos
Evangelos L
EL
Vassiliou
John G
JG
Voros
Dionisios C
DC
Fotopoulos
Alexis C
AC
Contis
John C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005260:Female; D006439:Hemodynamics; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008099:Liver / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome