[The Pringle maneuver in laparoscopic hepatic surgery: is it useful? Analysis of a series of 38 cases].
The Pringle maneuver is the most feasible method to control bleeding in hepatic resections in both open and laparoscopic approach. However its role in the mini-invasive surgery is still questionable. The aim of this study is to analyze our experience and to compare it to the literature data. This is a retrospective cohort study that includes all hepatic laparoscopic resections performed in our department between 1998-2007 and excludes all exploratory laparoscopies and all cases in which conversion to open procedure was imposed after the lesion assessment and in the absence on any intraoperative event. 38 hepatic laparoscopic resections were performed for both benign lesions (20 out of which 13 hemangiomas, 2 focal nodular hyperplasia, 1 liver cell adenoma, 2 hydatic cysts, 2 inflammatory lesions) and malignant lesions (18 out of which 8 metastases, 9 hepatocellular carcinoma, 1 cholangiocarcinoma). The tumor diameter ranged between 2 and 10 cm. There were 2 conversions to open procedures due to bleeding from hepatic veins collaterals. Pringle maneuver was never used. Pringle maneuver did not prove to be useful in our series because, on one hand, we performed only limited laparoscopic hepatic resections and, on the other hand, intraoperative bleeding was mainly due to lesions of the hepatic veins collaterals which cannot be influenced by clamping the hepatic pedicle. Even if there is no consensus, major laparoscopic hepatic resections may benefit from Pringle maneuver.
Popescu
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Centrul de Chirurgie Generală şi Transplant Hepatic, Institutul Clinic Fundeni, Bucureşti. irinel.popescu@icfundeni.ro
Vasile
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Sgarbură
Olivia
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D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008107:Liver Diseases / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome