title: A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy.
abstract: BACKGROUND
  blood loss during liver resection and the need for perioperative blood transfusions have negative impact on perioperative morbidity, mortality, and long-term outcomes.
  
  
  METHODS
  a randomized controlled trial was performed on patients undergoing liver resection comparing hemihepatic vascular inflow occlusion, main portal vein inflow occlusion, and Pringle maneuver. The primary endpoints were intraoperative blood loss and postoperative liver injury. The secondary outcomes were operating time, morbidity, and mortality.
  
  
  RESULTS
  a total of 180 patients were randomized into 3 groups according to the technique used for inflow occlusion during hepatectomy: the hemihepatic vascular inflow occlusion group (n = 60), the main portal vein inflow occlusion group (n = 60), and the Pringle maneuver group (n = 60). Only 1 patient in the hemihepatic vascular occlusion group required conversion to the Pringle maneuver because of technical difficulty. The Pringle maneuver group showed a significantly shorter operating time. There were no significant differences between the 3 groups in intraoperative blood loss and perioperative mortality. The degree of postoperative liver injury and complication rates were significantly higher in the Pringle maneuver group, resulting in a significantly longer hospital stay.
  
  
  CONCLUSIONS
  all 3 vascular inflow occlusion techniques were safe and efficacious in reducing blood loss. Patients subjected to hemihepatic vascular inflow occlusion, or main portal vein inflow occlusion responded better than those with Pringle maneuver in terms of earlier recovery of postoperative liver function. As hemihepatic vascular inflow occlusion was technically easier than main portal vein inflow occlusion, it is recommended.
authors.affiliation: The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Si-Yuan
authors.initials: SY
authors.lastname: Fu
authors.forename: F U
authors.initials: FU
authors.lastname: Si-Yuan
authors.forename: Wan-Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Lau Wan
authors.initials: LW
authors.lastname: Yee
authors.forename: Guang-Gang
authors.initials: GG
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Guang-Gang
authors.forename: Qing-He
authors.initials: QH
authors.lastname: Tang
authors.forename: Tang
authors.initials: T
authors.lastname: Qing-He
authors.forename: Ai-Jun
authors.initials: AJ
authors.lastname: Li
authors.forename: L I
authors.initials: LI
authors.lastname: Ai-Jun
authors.forename: Ze-Ya
authors.initials: ZY
authors.lastname: Pan
authors.forename: P A N
authors.initials: PA
authors.lastname: Ze-Ya
authors.forename: Gang
authors.initials: G
authors.lastname: Huang
authors.forename: Huang
authors.initials: H
authors.lastname: Gang
authors.forename: Lei
authors.initials: L
authors.lastname: Yin
authors.forename: Yin
authors.initials: Y
authors.lastname: Lei
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
authors.forename: W U
authors.initials: WU
authors.lastname: Meng-Chao
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
authors.forename: L A I
authors.initials: LA
authors.lastname: Eric
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Zhou
authors.forename: Zhou
authors.initials: Z
authors.lastname: Wei-Ping
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003250:Constriction; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery*; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011446:Prospective Studies