title: Comparison of major hepatectomy performed under intermittent Pringle maneuver versus continuous Pringle maneuver coupled with in situ hypothermic perfusion.
abstract: BACKGROUND
  The Pringle maneuver (hepatic inflow occlusion), applied intermittently or continuously, carries the risk of inducing ischemic and reperfusion injury. The risk of damage is higher in the latter procedure. Studies have shown that continuous Pringle maneuver coupled with in situ hypothermic perfusion (CPM-HP) circumvents such adversity. However, reports comparing this technique with the intermittent Pringle maneuver (IPM) are lacking. We therefore report our experience with the use of CPM-HP and compare its outcome with that of IPM.
  
  
  METHODS
  We evaluated the outcome of similar sets of patients who had major hepatic resections performed under IPM and CPM-HP. Variables including short-term survival rate (>90 days), complications, operative time, transection time, intraoperative blood loss, postoperative liver functions, and postoperative hospital stay were used to compare the two groups.
  
  
  RESULTS
  Eighteen major hepatectomies were performed with CPM-HP and 16 with IPM. CPM-HP was safely performed in patients with chronic liver disease. Lowering the liver's temperature extends the clamping period to 140 min. Perioperative outcomes including operative time (383.9 ± 89.4 vs. 351.9 ± 70.3 min, p = 0.252), blood loss (225.6 ± 48.4 vs. 351.9 ± 70.3 ml, p = 0.057), postoperative hospital stay, morbidity rate, and the rate of liver functions following resections were comparable for the CPM-HP and IPM groups. There was no mortality. Parenchymal transection time was significantly longer in the CPM-HP group (104.1 ± 20.2 vs. 85.0 ± 15.4 min, p = 0.004)
  
  
  CONCLUSIONS
  Our findings did not show there to be a significant advantage of CPM-HP over IPM.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan. ufel4996@ms26.hinet.net
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Anthony Q
authors.initials: AQ
authors.lastname: Yap
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007430:Intraoperative Care / Q000379:methods*; D008102:Liver Circulation / Q000502:physiology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010477:Perfusion / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D015427:Reperfusion Injury / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome