title: Anatomic mesohepatectomy with extrahepatic control of hepatic veins.
abstract: OBJECTIVE
  Intraoperative bleeding remains a major concern during mesohepatectomy because of doubled area of cut surface and proximity to important intrahepatic vascular structures. Preliminary extrahepatic exposure and looping of the main hepatic veins with the possibility of clamping them in association with total or partial vascular inflow occlusion, can lead to substantially reducing intraoperative bleeding.
  
  
  METHODS
  From January 2003 to July 2008, preliminary exposure and looping of the main hepatic veins was performed in 67 patients undergoing mesohepatectomy. Among these patients, mesohepatectomy was performed with clamping of more than one of the main hepatic veins in 47 patients. We report the results obtained in those patients.
  
  
  RESULTS
  Total vascular inflow occlusion with Pringle maneuver or partial vascular inflow occlusion based on an intrahepatic approach was used in all patients. The amount of intraoperative blood loss averaged (580 +/- 308) (range 180 to 4500) ml. No macroscopic tumor residue was encountered. There were no hospital deaths and the morbidity rate was 25.7%. The mean hospital stay was 11.2 days (range, 9-26).
  
  
  CONCLUSIONS
  Our study showed that preliminary extrahepatic control of the main hepatic veins was a safe and technically feasible maneuver. During mesohepatectomy, clamping more than one of the main hepatic veins, in association with total or partial vascular inflow occlusion, is efficacious in reducing intraoperative bleeding.
authors.affiliation: Department of General Surgery, Second Affiliated Hospital,Xiang Ya Medical College, Central South University, ChangSha, Hunan Province, PR China.
authors.forename: Xiong-Ying
authors.initials: XY
authors.lastname: Miao
authors.forename: Ji-Xiong
authors.initials: JX
authors.lastname: Hu
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Dai
authors.forename: De-Wu
authors.initials: DW
authors.lastname: Zhong
authors.forename: Sheng-Fu
authors.initials: SF
authors.lastname: Huang
authors.forename: Yu
authors.initials: Y
authors.lastname: Wen
authors.forename: Shou-Zhi
authors.initials: SZ
authors.lastname: Xiong
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged