Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure.
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.
Uchiyama
Kazuhisa
K
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Ueno
Masaki
M
Ozawa
Satoru
S
Hayami
Shinya
S
Kawai
Manabu
M
Tani
Masaji
M
Mizumoto
Kazuhiro
K
Haba
Masanori
M
Hatano
Yoshio
Y
Yamaue
Hiroki
H
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*