Intermittent pringle maneuver and hepatic function: perioperative monitoring by noninvasive ICG-clearance.
BACKGROUND
Intermittent Pringle maneuver or selective portal clamping often are used to control inflow during parenchymal liver transection. This study was designed to determinate whether these maneuvers are associated with adverse hepatic function.


METHODS
Resection was performed without portal clamping in 17 patients (group 1). Selective continuous portal clamping was performed in 11 patients (group 2) and the remaining 33 patients (group 3) had intermittent nonselective portal clamping (occlusion of the main portal trunk). The centers' protocol for total portal occlusion is 15-min occlusion alternated with 5-min reperfusion in patients with normal liver parenchyma or 10 min alternated with 5 min in patients with abnormal parenchyma. ICG elimination tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate (PDR-ICG-%/min) and 15-min retention rate after administration (ICG-R15-%).


RESULTS
There was no statistically difference between the three studied groups in terms of sequential changes of ICG-PDR (p < 0.625) or ICG-R15 (p < 0.398).


CONCLUSIONS
Our study indicates that 15 min of intermittent Pringle maneuver or selective hemihepatic continuous portal clamping are safe methods of vascular control during liver resection, with no adverse effects on hepatocellular function.
Tralhão
José Guilherme
JG
Departamento de Cirurgia, Serviço de Cirurgia III, Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000-075 Coimbra, Portugal. jglrt@hotmail.com
Hoti
Emir
E
Oliveiros
Bárbara
B
Abrantes
Ana M
AM
Botelho
M Filomena
MF
Castro-Sousa
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003250:Constriction; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects*; D006498:Hepatectomy / Q000379:methods; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000502:physiology / Q000601:surgery; D008102:Liver Circulation; D008107:Liver Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D015427:Reperfusion Injury; D013997:Time Factors