title: Liver resections can be performed safely without Pringle maneuver: A prospective study.
abstract: OBJECTIVE
  To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad.
  
  
  METHODS
  Between 9/2002 and 7/2013, 175 consecutive liver resections (n = 101 major anatomical and n = 74 large atypical > 5 cm) without Pringle maneuver were performed in 127 patients (143 surgeries). Accompanying, 37 wedge resections (specimens < 5 cm) and 43 radiofrequency ablations were performed. Preoperative volumetric calculation of the liver remnant preceeded all anatomical resections. The liver parenchyma was dissected by water-jet. The median central venous pressure was 4 mmHg (range: 5-14). Data was collected prospectively.
  
  
  RESULTS
  The median age of patients was 60 years (range: 16-85). Preoperative chemotherapy was used in 70 cases (49.0%). Liver cirrhosis was present in 6.3%, and liver steatosis of ≥ 10% in 28.0%. Blood loss was median 400 mL (range 50-5000 mL). Perioperative blood transfusions were given in 22/143 procedures (15%). The median weight of anatomically resected liver specimens was 525 g (range: 51-1850 g). One patient died postoperatively. Biliary leakages (n = 5) were treated conservatively. Temporary liver failure occurred in two patients.
  
  
  CONCLUSIONS
  Major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay.
authors.affiliation: Christoph A Maurer, Department of Surgery, Hirslanden-Clinic Beau-Site, 3013 Bern, Switzerland.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Maurer
authors.affiliation: Christoph A Maurer, Department of Surgery, Hirslanden-Clinic Beau-Site, 3013 Bern, Switzerland.
authors.forename: Mikolaj
authors.initials: M
authors.lastname: Walensi
authors.affiliation: Christoph A Maurer, Department of Surgery, Hirslanden-Clinic Beau-Site, 3013 Bern, Switzerland.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Käser
authors.affiliation: Christoph A Maurer, Department of Surgery, Hirslanden-Clinic Beau-Site, 3013 Bern, Switzerland.
authors.forename: Beat M
authors.initials: BM
authors.lastname: Künzli
authors.affiliation: Christoph A Maurer, Department of Surgery, Hirslanden-Clinic Beau-Site, 3013 Bern, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Lötscher
authors.affiliation: Christoph A Maurer, Department of Surgery, Hirslanden-Clinic Beau-Site, 3013 Bern, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Zuse
keywords: Blood loss; Liver resection; Pringle maneuver