Liver resection using a soft-coagulation system without the Pringle maneuver.
OBJECTIVE
The Pringle maneuver is generally performed to reduce the amount of blood loss during hepatic resection. We have developed a method to sufficiently control blood loss during hepatectomy without applying the Pringle maneuver. This study was performed to determine the safety and operative blood loss in hepatectomy performed by this new method.


METHODS
We performed 102 hepatic resections without the Pringle maneuver. We retrospectively compared the short-term operative outcome between these 102 cases and another 75 hepatic resections performed with the Pringle maneuver. The resections without the Pringle maneuver were performed using a soft-coagulation system.


RESULTS
The median length of the surgery using the soft-coagulation system without the Pringle maneuver was 135 minutes, significantly shorter than the surgical time required for resection with the Pringle maneuver 297 minutes (p<0.001). The median volume of operative blood loss was significantly lower in the non-Pringle-maneuver group (200cc vs. 704cc; p<0.001). Regarding postoperative liver function, AST, ALT, T-Bil and PT, levels were all significantly improved in the non-Pringle-maneuver group (p<0.01).


CONCLUSIONS
Our data suggest that hepatic resection using a soft-coagulation system without the Pringle maneuver is extremely safe and effective in controlling bleeding.
Department of Gastroenterological Surgery, Saitama Medical University, Saitama, Japan. kokamoto@saitama-med.ac.jp
Kojun
K
Okamoto
Isamu
I
Koyama
Yasuko
Y
Toshimitsu
Masayasu
M
Aikawa
Katsuya
K
Okada
Yosuke
Y
Ueno
Mitsuo
M
Miyazawa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation; D004566:Electrodes; D004867:Equipment Design; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007564:Japan; D008099:Liver / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D008102:Liver Circulation; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome