title: The introduction of a simple maneuver to reduce the risk of postoperative bleeding after major hepatectomies.
abstract: OBJECTIVE
  In major hepatectomies, postoperative increases in central venous pressure (CVP) may cause suture failure and massive bleeding. The aim of our study is to test the application of an intraoperative maneuver to reduce the risk of postoperative bleeding.
  
  
  METHODS
  Our study included 172 consecutive patients who had major liver resection with selective hepatic vascular exclusion and sharp transection of the liver parenchyma. An intraoperative maneuver (5 s occlusion of the hepatic vein) was applied in an alternating way, and the patients were assigned to two groups: Cohort A (n = 86), that was granted the maneuver, and Cohort B (n = 86), that was used as a control group.
  
  
  RESULTS
  In Cohort A, application of the maneuver was successful in demonstrating bleeders under low CVP levels. Cohort A had lower rate of massive bleeding requiring emergency reoperation (2.3 vs 5.8%, P = 0.049), less postoperative blood transfusions (13 vs 24%, P = 0.042), lower morbidity (20 vs 35%, P < 0.045) and shorter hospital stay compared to Cohort B.
  
  
  CONCLUSIONS
  Hepatectomies conducted under low CVP are prone to postoperative hemorrhage which can be prevented if the final bleeding control is performed under high pressure in the hepatic veins. Application of our testing maneuver effectively unmasked previously undetectable bleeding veins.
authors.affiliation: 2nd Department of Surgery, Athens University Medical School, Aretaieion Hospital, 76 Vasilissis Sofias Avenue, 11528, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vassiliou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Vaia
authors.initials: V
authors.lastname: Stafyla
authors.forename: Kassiani
authors.initials: K
authors.lastname: Theodoraki
authors.forename: Anneza
authors.initials: A
authors.lastname: Yiallourou
authors.forename: Theodosios
authors.initials: T
authors.lastname: Theodosopoulos
authors.forename: George
authors.initials: G
authors.lastname: Kotis
authors.forename: George
authors.initials: G
authors.lastname: Fragoulidis
authors.forename: Thomas
authors.initials: T
authors.lastname: Kotsis
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002496:Central Venous Pressure; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D055815:Young Adult