Continuous versus intermittent portal triad clamping during hepatectomy in cirrhosis. Results of a prospective, randomized clinical trial.
OBJECTIVE
It has been shown that hepatic pedicle clamping is a safe and effective technique to control bleeding during liver resection. A major drawback can be the induction of liver ischemia and splanchnic venous stasis.


METHODS
This randomized controlled clinical trial compared continuous and intermittent hepatic pedicle clamping during resection of the cirrhotic liver in order to determine which technique is more effective in reducing operative blood loss and producing less ischemic injury. In 18 patients we performed continuous portal triad clamping during liver transection while in 17 patients we performed intermittent clamping. The two groups matched for extent of resection. Serial hepatic function tests were performed on postoperative day 1, 3 and 7.


RESULTS
No significant difference was found between the two groups in terms of operative findings. Operative mortality was 5.7% (2 patients). Six patients (17.3%) had postoperative complications. There were no significant differences between the two groups with regard to postoperative liver function tests and coagulation profile.


CONCLUSIONS
Continuous and intermittent clamping are both effective in reducing blood loss during hepatectomy in cirrhosis. The two techniques seem to be comparable in terms of ischemic injury. Our findings suggest that intermittent portal triad clamping may not be necessary. As this is contrary to the normal expectancy, additional studies may be needed.
Capussotti
Lorenzo
L
Ospedale Mauriziano Umberto I, Department of Surgery, Largo Turati 62, 10128 Torino, Italy.
Nuzzo
Gennaro
G
Polastri
Roberto
R
Giuliante
Felice
F
Muratore
Andrea
A
Giovannini
Ivo
I
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000601:surgery*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011168:Portal System; D011446:Prospective Studies