title: Surgical treatment of giant liver hemangiomas: enucleation with continuous occlusion of hepatic artery proper and intermittent Pringle maneuver.
abstract: BACKGROUND
  The present study was designed to investigate the efficacy and safety of continuous occlusion of the hepatic artery proper combined with intermittent use of the Pringle maneuver for reduction of blood loss during enucleation of giant liver hemangiomas.
  
  
  METHODS
  A retrospective study was performed on 115 patients who underwent enucleation of giant liver hemangiomas with or without continuous occlusion of the hepatic artery proper at a tertiary care university hospital. The characteristics of patients and perioperative parameters including intraoperative blood loss, the degree of ischemia-reperfusion injury, the incidence and severity of postoperative complications, and the length of hospital stay were summarized and compared in the two groups.
  
  
  RESULTS
  Seventy-three and 42 patients underwent enucleation of hepatic hemangiomas with and without continuous occlusion of the hepatic artery proper, respectively. The Pringle maneuver was routinely used in all patients in cycles of 15/5 min of clamp/unclamp times. Patient characteristics were comparable between the two groups. Intraoperative blood loss and blood transfusion in the continuous occlusion group were significantly lower than in the non-occlusion group (P < 0.001 and P = 0.012, respectively). In a comparison of the two groups, there were no significant differences in the changes of the perioperative serum aspartate transaminase and total bilirubin levels (P = 0.086, P = 0.829, respectively), and in the postoperative hospital stay and surgical complications according to Clavien's classification (P = 0.378, P = 0.227, respectively).
  
  
  CONCLUSIONS
  Continuous occlusion of the hepatic artery proper when added to intermittent use of the Pringle maneuver significantly reduced intraoperative blood loss when compared with intermittent Pringle maneuver alone. Enucleation of giant hepatic hemangiomas using continuous occlusion of the hepatic artery proper in addition to intermittent application of the Pringle maneuver for up to 1 h was safe.
authors.affiliation: Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. frankfxia@gmail.com
authors.forename: Feng
authors.initials: F
authors.lastname: Xia
authors.forename: Wan-Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Cheng
authors.initials: C
authors.lastname: Qian
authors.forename: Shuguang
authors.initials: S
authors.lastname: Wang
authors.forename: Kuansheng
authors.initials: K
authors.lastname: Ma
authors.forename: Ping
authors.initials: P
authors.lastname: Bie
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003250:Constriction; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D001663:Bilirubin