The renal sequelae of a novel triphasic approach to blood loss reduction during hepatic resection.
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.
Moug
S J
SJ
Academic Department of Surgery, Glasgow Royal Infirmary, Queen Elizabeth Building, Alexandra Parade, Glasgow G31 2ER, UK.
Smith
D
D
Wilson
I S
IS
Leen
E
E
Horgan
P G
PG
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*
D003404:Creatinine