The main indications and techniques for vascular exclusion of the liver.
BACKGROUND
The purpose of vascular clamping during the course of liver resection is to reduce bleeding and subsequent complications.


OBJECTIVE
To show both step-by-step surgical techniques for vascular exclusion of the liver and their indications.


METHODS
It is described the following techniques: clamping of the hepatic pedicle, "Pringle" maneuver; intermittent clamping of the hepatic pedicle; intermittent vascular exclusion of the liver, without vena cava clamping, and hepatic vascular exclusion with vena cava clamping. Also metabolic and homodynamic consequences as well as the technical failure of the application of each of them are discussed.


CONCLUSIONS
The choice of technique to use for clamping during hepatectomy depends on the surgeon's judgment. Dogmatic or systematic attitude, is prejudiciable for the patient and liver surgeon must be able to use all kinds of clamping.
Chaib
Eleazar
E
Liver and Portal Hypertension Surgery Unit, University of São Paulo School of Medicine, São Paulo, SP, Brazil. cientifico@uol.com.br
Saad
William Abrão
WA
Fujimura
Ikurou
I
Saad
Willian Abrão
WA
Gama-Rodrigues
Joaquim
J
D003250:Constriction; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000601:surgery