Feasibility of hanging maneuvers in orthotopic liver transplantation with inferior vena cava preservation and in liver surgery.
OBJECTIVE
The aim of this work was to study the feasibility and complication rates of liver hanging maneuvers: the Belghiti liver hanging maneuver (BLHM) in liver resection and the modified liver hanging maneuver (MLHM) in orthotopic liver transplantation (OLT) with inferior vena cava (IVC) preservation.


METHODS
From January 2001 to August 2003, BLHM was planned in 26 consecutive right hepatectomies and MLHM in 28 consecutive OLTs with IVC preservation.


RESULTS
BLHM was performed in 24/26 patients (92%). In the 2 remaining patients, chronic biliary infection (n = 1) and intraparenchymal hemorrhagic hepatocellular carcinoma (n = 1) did not allow BLHM to be achieved. Bleeding during the BLHM procedure occurred in 1 patient (4%), with no need for interruption. MLHM was performed in all 28 patients, and in none of them was bleeding observed during the maneuver.


CONCLUSIONS
BLHM and MLHM are important technical refinements with several advantages. Feasibility rates were 92% and 100%, respectively. Bleeding risk remained low (4%) for BLHM and was 0% for MLHM. The rate of BLHM failure suggests that the feasibility rate may be higher in normal liver parenchyma.
Ettorre
Giuseppe Maria
GM
Department of Digestive Surgery and Liver Transplantation, Regina Elena Cancer Institute, Via E. Chianesi 53, 00144, Rome, Italy.
Vennarecci
Giovanni
G
Boschetto
Arianna
A
Douard
Richard
R
Santoro
Eugenio
E
D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005240:Feasibility Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D014682:Vena Cava, Inferior