title: Extrahepatic portal vein ligation in major hepatectomies performed under selective vascular exclusion: a case-control study.
abstract: The aim of our study is to assess the effect of extrahepatic ipsilateral portal vein branch ligation in hepatectomies conducted under selective hepatic vascular exclusion with sharp transection of the liver parenchyma. Twenty-six patients (Group A) underwent major hepatectomy from January  2007 to December 2009, and hemostasis was achieved by ligation of the ipsilateral portal vein branch in addition to suture ligation of the cut surface vessels. A control group (Group B) was composed of 26 matched patients picked from our hospital's database, in which hemostasis was achieved  by suture ligation of the cut surface vessels only. Warm ischemia time, intraoperative blood loss, blood transfusions, and liver function were compared. Reduced blood loss (450 vs 680 mL, P = 0.03), less transfusions (8 vs 20% of the patients, P = 0.04), and decreased  warm ischemia time (34 vs 42 minutes, P = 0.04) were observed in Group A. Extrahepatic ligation of the ipsilateral portal vein branch is simple, safe, and effective in reducing blood loss and warm ischemia time in major hepatectomies performed under selective vascular exclusion.
authors.affiliation: 4th Department of Surgery, Athens University School of Medicine, Areteion University Hospital, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Maria A
authors.initials: MA
authors.lastname: Kyriazi
authors.forename: Kassiani
authors.initials: K
authors.lastname: Theodoraki
authors.forename: George
authors.initials: G
authors.lastname: Sakorafas
authors.forename: Aliki
authors.initials: A
authors.lastname: Tympa
authors.forename: John
authors.initials: J
authors.lastname: Skalkidis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vassiliou
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000601:surgery; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011859:Radiography; D013536:Suture Techniques; D016896:Treatment Outcome