title: Hemihepatic versus total hepatic inflow occlusion during hepatectomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion (HHO) compared with total hepatic inflow occlusion (THO).
  
  
  METHODS
  Randomized controlled trials (RCTs) comparing hemihepatic vascular occlusion and total hepatic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta-analysis was conducted to estimate blood loss, transfusion requirement, and liver injury based on the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Either the fixed effects model or random effects model was used.
  
  
  RESULTS
  Four RCTs including 338 patients met the predeﬁned inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Meta-analysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean difference (WMD) 342.27; 95% confidence intervals (CI) 217.28-467.26; P = 0.00 001; I(2) = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7.
  
  
  CONCLUSIONS
  Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections.
authors.affiliation: Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Hai-Qing
authors.initials: HQ
authors.lastname: Wang
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.forename: Lu-Nan
authors.initials: LN
authors.lastname: Yan
mesh_terms: D001219:Aspartate Aminotransferases / Q000378:metabolism; D016063:Blood Loss, Surgical; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D001219:Aspartate Aminotransferases