title: Blocking intrahepatic inflow and backflow using Chang's needle during hepatic resection: Chang's maneuver.
abstract: BACKGROUND
  Chang's needle is a straight, 18-gauge stainless steel needle with a hook near its top to catch the thread and can be used for various hepatic resections. Since its introduction in 1996, accumulated experience has shown that using Chang's needle is simple and safe. We recently explored a new application for the needle with an intrahepatic vascular block during hepatic resections.
  
  
  METHODS
  Using Chang's needle makes whole-thickness interlocking sutures of the liver possible. One or two rows of multiple sutures secure the inflow and backflow while allowing a hepatic parenchymal division with less blood loss. Under ultrasound guidance, single temporary sutures can be made in the respective branches of the Glisson sheath to block inflow, and, on the right or left hepatic vein, to block backflow as well.
  
  
  RESULTS
  We did 89 hepatic resections without specifically aimed inflow or backflow blocks, including 12 right lobectomies, three trisegmentectomies, 21 bisegmentectomies, and 15 segmentectomies. Twenty-seven patients had mild to severe liver cirrhosis. Specifically aimed inflow blocks for partial hepatic resections were done on the Glisson sheath (G) of segment 8 (two patients), segment 6 (one patient), and segment 3 (one patient). One patient with a G8 block had a concomitant backflow block of the right hepatic vein. Overall, there was no procedure-related mortality or hepatic failure. Ischemia and reperfusion induced liver function deterioration was minimal in the group with this kind of temporary vascular blocks.
  
  
  CONCLUSIONS
  In addition to hepatic resections, Chang's maneuver can be used for intrahepatic individual inflow or backflow blocks, or both, to minimize ischemic and reperfusion injuries.
authors.affiliation: Department of Surgery, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan. changmdphd@yahoo.com
authors.forename: Y C
authors.initials: YC
authors.lastname: Chang
authors.forename: N
authors.initials: N
authors.lastname: Nagasue
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