A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors.
OBJECTIVE
To evaluate whether continuous hemihepatic inflow occlusion (HHO) during hepatectomy can be safer than and be as effective as intermittent total hepatic inflow occlusion (THO) in reducing blood loss.


METHODS
Eighty patients undergoing liver resections were included in a prospective randomized study comparing the intra- and postoperative course under THO (n=40) or HHO (n=40). THO was performed with periods of 20 minutes of occlusion and 5 minutes of releasing, while HHO was performed with continuous occlusion. The surface area of liver transection, amount of blood loss, measurements of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and postoperative evolution were recorded.


RESULTS
The two groups were similar at entry in terms of preoperative liver function and in the proportion of patients experiencing major hepatectomy. The total ischemic time of the two groups was similar (p=0.37), but the operative time in the THO group was longer than in the HHO group (p=0.02). No significant difference was found between the HHO and THO group in blood loss during liver parenchyma transection (p=0.14), the elevations of ALT and AST on the first postoperative day (ALT: p=0.12; AST: p=0.66) and postoperative morbidity (p=0.35).


CONCLUSIONS
On the basis of our findings, if it is feasible, continuous HHO is recommended for complex liver resection.
Liang
Guanlin
G
Division of Liver Surgery and Liver Transplantation, West China Hospital, West China Medical School of Sichuan University, Chengdu 610041, China.
Wen
Tianfu
T
Yan
Lunan
L
Li
B O
BO
Wu
Guochang
G
Yang
Jian
J
Lu
Bo
B
Chen
Zheyu
Z
Liao
Zhixue
Z
Ran
Shun
S
Yu
Zhang
Z
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome