You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 129 No. 10, October 1994 TABLE OF CONTENTS
  Archives
  •  Online Features
  Original Articles
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

One Hundred Consecutive Hepatic Resections

Blood Loss, Transfusion, and Operative Technique

John D. Cunningham, MD; Yuman Fong, MD; Craig Shriver, MD; Jose Melendez, MD; William L. Marx, MD; Leslie H. Blumgart, MD, FRCS

Arch Surg. 1994;129(10):1050-1056.


Abstract

Background
Hepatic resection is prone to significant blood loss. Adverse effects of blood loss and transfusion mandate improvements in surgical techniques to reduce blood loss and transfusion requirements.

Methods
One hundred hepatic resections were carried out using a standard surgical technique that includes control of the hilar structures, extrahepatic control of the hepatic veins, and use of the Pringle maneuver. Low central venous pressure and Trendelenburg positioning were used during parenchymal transection. Data were collected retrospectively in the first 36 patients, whereas data were collected prospectively in the remaining 64 patients.

Results
Hospital mortality was 3%. Median blood loss was 450, 700, 1000, 1100, and 1500 mL for segmental, nonanatomic, lobar, extended right, and extended left resections, respectively. Major resections were more likely than minor resections to be transfused with albumin (P=.008), fresh frozen plasma (P=.009), and packed red blood cells or whole blood (P=.04). Overall transfusion of packed red blood cells or whole blood occurred in 59 of 100 patients. In the 64 patients who were followed up prospectively, the predeposit of autologous blood decreased the need for homologous transfusions from 56% to 38%. A further reduction in the transfusion rate to 25% could have been possible if all patients in the prospective group had donated 2 U of autologous blood. Patients who predeposited blood were more likely to receive transfusions and to have had a transfusion more than 24 hours after surgery than were patients who did not donate blood.

Conclusions
The surgical techniques used result in acceptable blood loss and transfusion requirements for hepatic resection. This approach is safe, cost-effective, reproducible, and applicable for widespread use.

(Arch Surg. 1994;129:1050-1056)



Author Affiliations

From the Departments of Surgery (Drs Cunningham, Fong, Shriver, and Blumgart) and Anesthesia (Drs Melendez and Marx), Memorial Sloan-Kettering Cancer Center, New York, NY.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Portal Vein Embolization and Autologous CD133+ Bone Marrow Stem Cells for Liver Regeneration: Initial Experience
Furst et al.
Radiology 2007;243:171-179.
ABSTRACT | FULL TEXT  

The use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia.
De Pietri et al.
Anesth. Analg. 2006;102:1157-1163.
ABSTRACT | FULL TEXT  

Hepatic Resection by the Cavitron Ultrasonic Surgical Aspirator(R) Increases the Incidence and Severity of Venous Air Embolism
Koo et al.
Anesth. Analg. 2005;101:966-970.
ABSTRACT | FULL TEXT  

Extended Hepatectomy in Patients With Hepatobiliary Malignancies With and Without Preoperative Portal Vein Embolization
Abdalla et al.
Arch Surg 2002;137:675-681.
ABSTRACT | FULL TEXT  

Effect of Hypoventilation on Bleeding During Hepatic Resection: A Randomized Controlled Trial
Hasegawa et al.
Arch Surg 2002;137:311-315.
ABSTRACT | FULL TEXT  

Randomized Comparison of Ultrasonic vs Clamp Transection of the Liver
Takayama et al.
Arch Surg 2001;136:922-928.
ABSTRACT | FULL TEXT  

Major Hepatic Resection: Indications and Results in a National Hospital System From 1988 to 1992
Nadig et al.
Arch Surg 1997;132:115-119.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1994 American Medical Association. All Rights Reserved.