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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.

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