title: Meta-analysis of intermittent Pringle manoeuvre versus no Pringle manoeuvre in elective liver surgery.
abstract: OBJECTIVE
  Intermittent Pringle manoeuvre (IPM) is frequently used during liver surgery. This meta-analysis aimed to review the impact on blood loss, operating time and morbidity and mortality with and without use of IPM.
  
  
  METHODS
  An electronic search was performed of the MEDLINE, EMBASE, PubMed databases using both subject headings (MeSH) and truncated word searches to identify all articles published that related to this topic. Pooled risk ratios were calculated for categorical outcomes, and mean differences (MDs) for secondary continuous outcomes, using the fixed-effects and random-effects models for meta-analysis.
  
  
  RESULTS
  Four randomized controlled trials encompassing 392 patients were analysed to achieve a summated outcome. Pooled data analysis showed the use of IPM resulted in reduced transection time/cm(2) (MD -0.53 (-0.88, -0.18) min/cm(2) (P = 0.003)) but with comparable blood loss (mL/cm(2)) (MD -1.67 (-4.41, 1.08) mL/cm(2), P = 0.23), overall blood loss (MD -20.42 (-89.42, 48.58) mL), blood transfusion requirements (risk ratio 0.78 (0.40, 1.52, P = 0.47)) and morbidity and mortality compared to no Pringle manoeuvre. In addition, there was no significant difference in the post-operative hospital stay (MD 0.37 (-0.60, 1.34) days).
  
  
  CONCLUSIONS
  There is no evidence that the routine use of IPM improves perioperative and post-operative outcomes compared to no Pringle manoeuvre and its routine may not be recommended.
authors.affiliation: Department of HPB Surgery, Royal Infirmary, Edinburgh, UK.
authors.forename: Pandanaboyana
authors.initials: P
authors.lastname: Sanjay
authors.forename: Ian
authors.initials: I
authors.lastname: Ong
authors.forename: Adam
authors.initials: A
authors.lastname: Bartlett
authors.forename: James J
authors.initials: JJ
authors.lastname: Powell
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wigmore
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D015233:Models, Statistical; D061646:Operative Time; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Pringle; Pringle manoeuvre; inflow occlusion liver resection; liver surgery