Bleeding in liver surgery: prevention and treatment.
Intraoperative blood loss and transfusion of blood products are negatively associated with postoperative outcome after liver surgery. Blood loss can be minimized by surgical methods, including vascular clamping techniques, the use of dissection devices, and the use of topical hemostatic agents. Preoperative correction of coagulation tests with blood products has not been shown to reduce intraoperative bleeding and it may, in fact, enhance the bleeding risk. Maintaining a low central venous pressure has been shown to be effective in reducing blood loss during partial liver resections, and volume contraction rather than prophylactic transfusion blood products seems justified in patients undergoing major liver surgery. Although antifibrinolytic drugs have proved to be effective in reducing blood loss during liver transplantation, systemic hemostatic drugs are of limited value in reducing blood loss in patients undergoing partial liver resections.
Alkozai
Edris M
EM
Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Lisman
Ton
T
Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Porte
Robert J
RJ
Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: r.j.porte@chir.umcg.nl.
D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D007611:Aprotinin / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use; D006498:Hepatectomy; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D016343:Monitoring, Intraoperative; D014148:Tranexamic Acid / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D014148:Tranexamic Acid; D007611:Aprotinin