title: Complete hemihepatic vascular exclusion versus pringle maneuver for liver resection: a comparative study.
abstract: OBJECTIVE
  This non-randomized study aimed to compare the perioperative outcomes of complete hemihepatic vascular exclusion (CHVE) vs. Pringle maneuver in partial hepatectomy.
  
  
  METHODS
  From February 2006 to September 2008, 129 consecutive patients with resectable tumors confined to a hemi-liver underwent hepatic resection with CHVE (n=55) or Pringle maneuver (n=74). The surgical outcomes were compared.
  
  
  RESULTS
  The vascular clamp time in the CHVE group was significantly longer than the Pringle group (mean, 35.3min vs. 25.3min). The operating time and the liver transection time in the CHVE group were significantly longer. Blood loss and blood loss per transection surface area was significantly lower in the CHVE group than the Pringle group. The CHVE group had significantly fewer patients who required blood transfusion (n=8 vs. n=23). Both groups had similar complication rates (18.2% vs. 23%). There was no procedure-related mortality. The serum pre-albumin levels on days 3 and 7 after operation in the CHVE group were significantly higher than the Pringle group. The serum ALT levels on days 1, 3 and 7 after operation in the CHVE group were significantly lower than the Pringle group. There were no significant differences in the postoperative serum total bilirubin levels between the two groups.
  
  
  CONCLUSIONS
  CHVE is safe and feasible in selected patients. Using CHVE during liver transection resulted in less blood loss and less hepatic ischemia-reperfusion injury in the early postoperative period than using Pringle maneuver.
authors.affiliation: Department of Special Treatment, Second Military Medical University, Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Tong
authors.forename: Jia-Mei
authors.initials: JM
authors.lastname: Yang
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply; D008113:Liver Neoplasms / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged