title: Perioperative analysis of laparoscopic liver resection with different methods of hepatic inflow occlusion.
abstract: BACKGROUND
  During liver resection, bleeding remains the most important challenge. A reduction in blood loss and avoiding the need for a blood transfusion are important objectives for liver surgeons today. The authors compared the intra- and postoperative course of patients undergoing laparoscopic liver resections under intermittent total pedicle occlusion (IPO), hemihepatic vascular occlusion (HVO), and selective vascular occlusion (SVO).
  
  
  METHODS
  Retrospective analysis was conducted of patient data from 41 cases of laparoscopic liver resection in three groups of patients under different occlusion methods, including 15 cases of IPO, 15 cases of HVO, and 11 cases of SVO. The advantages and disadvantages of the various methods were compared, as well as blood loss, operation time, changes in postoperative liver function, and complications.
  
  
  RESULTS
  There was no operative death in any of the 41 patients. Generally, there was no significant difference among the three groups in blood loss, clamping time, or operative time. After the operation, the effect on liver function for the HVO and SVO groups was significantly less severe than that for the IPO group (P<.05). The incidence of postoperative complications was mainly related to IPO and the larger amount of bleeding.
  
  
  CONCLUSIONS
  Both HVO and SVO are feasible in laparoscopic hepatectomy and have the advantage of reducing liver remnant ischemia injury and modality rate over IPO. HVO is easy to do for left lateral lobe or resection of the left half of the liver. SVO is suitable for right lobe resection.
authors.affiliation: Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: JingWang
authors.initials: J
authors.lastname: Tan
authors.forename: YunChang
authors.initials: Y
authors.lastname: Tan
authors.forename: YuLi
authors.initials: Y
authors.lastname: Zhu
authors.forename: Ke
authors.initials: K
authors.lastname: Chen
authors.forename: BenShun
authors.initials: B
authors.lastname: Hu
authors.forename: HuaMin
authors.initials: H
authors.lastname: Tan
authors.forename: XiangMin
authors.initials: X
authors.lastname: Ding
authors.forename: JianJun
authors.initials: J
authors.lastname: Leng
authors.forename: Fei
authors.initials: F
authors.lastname: Chen
authors.forename: JiaHong
authors.initials: J
authors.lastname: Dong
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical; D003250:Constriction; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006503:Hepatic Veins; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000098:blood supply* / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods; D019990:Perioperative Care / Q000379:methods; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011228:Prealbumin / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D013525:Surgical Instruments; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D011228:Prealbumin