title: The renal sequelae of a novel triphasic approach to blood loss reduction during hepatic resection.
abstract: OBJECTIVE
  To report our novel triphasic approach to minimising blood loss during hepatic resection and the renal sequelae.
  
  
  METHODS
  Fifty consecutive patients (median age 63.3 years, range 37-86) underwent hepatic resection. Triphasic approach consisted of: pre-operative bowel preparation with no supplementary fluids; intraoperative intravenous fluid restriction with low central venous pressure (<5 cmH2O) and continuous selective occlusion of the left or right portal structures and corresponding hepatic vein/s. The following variables were analysed: blood loss; transfusion requirements; perioperative renal function; perioperative morbidity and mortality.
  
  
  RESULTS
  Median estimated blood loss was 330 mL (range 50-1200). No patient was transfused intraoperatively, with two patients transfused post-operatively. Median intraoperative urine output prior to hepatic re-perfusion was 28.4 mL/h (range 13.3-40.0) with no patient developing renal impairment. Morbidity occurred in 22% of patients with no documented hepatic failure. There was zero 30-day mortality.
  
  
  CONCLUSIONS
  Pre-operative dehydration and intraoperative fluid restriction combined with continuous selective vascular occlusion minimizes blood loss during hepatic resection with no consequent detriment to renal function.
authors.affiliation: Academic Department of Surgery, Glasgow Royal Infirmary, Queen Elizabeth Building, Alexandra Parade, Glasgow G31 2ER, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Moug
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.forename: I S
authors.initials: IS
authors.lastname: Wilson
authors.forename: E
authors.initials: E
authors.lastname: Leen
authors.forename: P G
authors.initials: PG
authors.lastname: Horgan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007668:Kidney / Q000503:physiopathology*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D014563:Urodynamics / Q000502:physiology*
chemical_list: D003404:Creatinine