title: The impact of intraoperative vascular occlusion during liver surgery on postoperative peak ALT levels: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Intraoperative vascular occlusion techniques during liver surgeries have been performed and refined for decades. However, the impact of these techniques on postoperative peak ALT levels remains uncertain. Thus, we performed a literature review and meta-analysis to determine the impact of intraoperative vascular occlusion during liver surgery on postoperative peak ALT levels.
  
  
  METHODS
  A systematic literature search of the PubMed database was conducted to discover relevant controlled clinical trials. Studies that reported postoperative peak ALT values for both an observation group and a control group were included. The Q statistic and the I(2) index statistic were used to assess heterogeneity. Publication bias was evaluated using Egger's test and Orwin's fail-safe N test.
  
  
  RESULTS
  Of the 281 retrieved articles, 10 articles fulfilled the inclusion criteria. These 10 articles involved 12 randomized controlled trials with a total of 1443 records. The pooled estimation results indicated that intraoperative vascular occlusion significantly elevated postoperative peak ALT levels (test for SMD: Z = 4.09, P < 0.001; 95% CI: 0.59-1.68), with high heterogeneity (I(2) = 93.8%). Subgroup analysis revealed that intermittent inflow occlusion and Pringle's maneuver vascular occlusions may be the potential crucial factors. No obvious publication bias was detected by Egger's test (P = 0.541) or Orwin's fail-safe N test (Nfs0.05 = 2059.19).
  
  
  CONCLUSIONS
  Intraoperative vascular occlusion, especially intermittent inflow occlusion and Pringle's maneuver vascular occlusions, may be a potential risk factor that could lead higher postoperative peak ALT values than non-occlusion procedures for liver surgeries.
authors.affiliation: Department of General Surgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, PR China.
authors.forename: Tao
authors.initials: T
authors.lastname: Guo
authors.affiliation: Department of General Surgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, PR China.
authors.forename: Yusha
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Department of General Surgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, PR China.
authors.forename: Zhisu
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, PR China. Electronic address: lqy@whu.edu.cn.
authors.forename: Quanyan
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications; D008099:Liver / Q000601:surgery; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014652:Vascular Diseases / Q000209:etiology*
chemical_list: D000410:Alanine Transaminase
keywords: ALT; Meta-analysis; Vascular occlusion