Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver.
BACKGROUND
Control of blood loss is a crucial problem during hepatectomy. Bleeding from the inflow system can be controlled by the Pringle maneuver or selective vascular occlusion. Bleeding from the outflow system is closely related to central venous pressure (CVP). Therefore, in this study, we evaluated whether vascular outflow control by clamping the inferior vena cava (IVC) below the liver (IVC clamping) during hepatectomy is a safe and effective method to reduce blood loss and CVP.


METHODS
We reviewed the outcomes of 103 consecutive patients whose CVP values were >5 cm H(2)O and who had undergone right or left hemihepatectomy between 1995 and 2000. Forty-seven patients who underwent hepatectomy with IVC clamping (Group A) between 1998 and 2000 were compared with the previous 56 patients who underwent hepatectomy without IVC clamping between 1995 and 1997 (Group B).


RESULTS
The CVP decreased by 3.7 cm H(2)0 after IVC clamping. Estimated blood loss was 910 mL in Group A and 1177 mL in Group B. (P=.008) No severe renal or cardiovascular damage occurred after IVC clamping.


CONCLUSIONS
IVC clamping is very effective in reducing blood loss during hepatectomy when the CVP is elevated and cannot be reduced pharmacologically or by fluid restriction.
Otsubo
Takehito
T
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Takasaki
Ken
K
Yamamoto
Masakazu
M
Katsuragawa
Hideo
H
Katagiri
Satoshi
S
Yoshitoshi
Kenji
K
Hamano
Mie
M
Ariizumi
Shun-Ichi
S
Kotera
Yoshihito
Y
D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002496:Central Venous Pressure; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior