This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on ISI (15)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Liver/ Biliary Tract/ Pancreatic Diseases  • Blood/ Coagulation  • Hepatobiliary Surgery  • Alert me on articles by topic

A Randomized Comparison of Hemihepatic and Total Hepatic Occlusion Techniques

Cheng-Chung Wu, MD; Dah-Cherng Yeh, MD; Wai-Meng Ho, MD; Chu-Leng Yu, MD; Shao-Bin Cheng, MD; Tse-Jia Liu, MD; Fang-Ku P'eng, MD

Arch Surg. 2002;137:1369-1376.

Background  Intermittent occlusion of hepatic blood inflow by means of a hemihepatic or total hepatic occlusion technique is essential for reducing operative blood loss. Central liver resection to preserve more functioning liver parenchyma is mandatory for centrally located liver tumors in patients with cirrhosis, but it requires a longer overall hepatic ischemic time because of a wide transection plane. No controlled comparison has been performed for the 2 techniques in these operations.

Hypothesis  Hemihepatic inflow occlusion may be beneficial in cirrhotic patients who undergo complex central hepatectomy with a wide liver transection plane.

Design  A prospective, randomized study.

Setting  University hospital and tertiary referral center.

Patients  During liver parenchymal transection, 58 cirrhotic patients who underwent complex central liver resections with a wide transection plane were prospectively randomized into 2 groups. In the group undergoing total hepatic inflow clamping (group T; n = 28), occlusion of hepatic blood inflow was performed for 15 minutes with declamping for 5 minutes. In the group undergoing selective clamping of ipsilateral blood inflow (group H; n = 30), clamping was performed for 30 minutes with declamping for 5 minutes.

Intervention  Comparison of patient backgrounds, operative procedures, and early postoperative results.

Main Outcome Measures  Operative blood loss, need for blood transfusion, and postoperative morbidity.

Results  The patients' backgrounds, operative procedures, and area of liver transection plane were not significantly different between the 2 groups. In all patients, the liver transection areas were greater than 60 cm² and overall liver ischemic times were greater than 60 minutes. The amount of operative blood loss and incidence of blood transfusion were significantly greater in group T because of greater blood loss during declamping. Overall liver ischemic and total operative times, postoperative morbidity, and postoperative changes in liver enzyme levels were not significantly different between groups. No in-hospital deaths occurred in either group.

Conclusions  Intermittent hemihepatic and total occlusion of hepatic blood inflow are safe in cirrhotic patients with an overall ischemic time of greater than 60 minutes. However, for complex liver resections with an estimated liver transection plane of greater than 60 cm², hemihepatic occlusion of blood inflow, if feasible, may be recommended in cirrhotic patients to reduce operative blood loss and the incidence of blood transfusion under our defined occlusion time.

From the Departments of Surgery (Drs Wu, Yeh, Yu, Cheng, Liu, and P'eng) and Anesthesiology (Dr Ho), Taichung Veterans General Hospital, Chung-Shan Medical University, Taichung, Taiwan, and the Department of Surgery, Faculty of Medicine, National Yang-Ming University (Drs Wu, Yeh, Yu, Cheng, Liu, and P'eng), Taipei, Taiwan.