title: Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure.
abstract: OBJECTIVE
  Bleeding from the hepatic vein is closely related to central venous pressure (CVP). To evaluate the effect of low central venous pressure during a hepatectomy, the infrahepatic inferior vena cava (IVC) was half clamped.
  
  
  METHODS
  Between 2006 and 2007, 20 patients undergoing major hepatectomy with the IVC half clamping (half-clamping group) were compared with 58 patients undergoing hepatectomy without IVC half clamping between 2003 and 2005 (control group). The types of liver resection, amount of blood loss during the hepatectomy, volume of blood transfusion, length of hospital stay, and complications were compared between the two groups.
  
  
  RESULTS
  In the half-clamping group, blood loss was decreased in comparison to the control group (p = 0.041) and the suprahepatic CVP was low (2.4 +/- 1.8 mmHg; p = 0.0002). The diameter at the root of the right hepatic vein was reduced in comparison to before clamping (5.8 +/- 1.6 mm; p < 0.001). There were no complications of half clamping on any hemodynamic and blood electrolytic parameters.
  
  
  CONCLUSIONS
  Using the half clamping technique of the IVC, intra-operative CVP was maintained below 3 mmHg without any side effects, and the low CVP significantly reduced the bleeding from hepatic veins during a major hepatectomy.
authors.affiliation: Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Satoru
authors.initials: S
authors.lastname: Ozawa
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayami
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mizumoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Haba
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hatano
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control*; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D002496:Central Venous Pressure / Q000502:physiology*; D018281:Cholangiocarcinoma / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*