Hepatic resections in normothermic ischemia

• Published in: Surgery Vol. 120; no. 5; pp. 852 - 858
• Main Authors: Nuzzo, Gennaro, Giuliante, Felice, Giovannini, Ivo, Tebala, Giovanni D., de Cosmo, Germano
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.1996; Elsevier
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Adolescent; Adult; Aged; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Loss, Surgical - prevention & control; Child; Child, Preschool; Evaluation Studies as Topic; Female; Humans; Ischemia; Ligation; Liver - blood supply; Liver - surgery; Liver Circulation; Liver Diseases - physiopathology; Liver Diseases - surgery; Liver Neoplasms - blood supply; Liver Neoplasms - surgery; Male; Medical sciences; Middle Aged; Postoperative Complications - prevention & control; Temperature; Human; Postoperative; Normothermia; Liver; General anesthesia; Hepatic disease; Surgical resection; Hemorrhage; Result; Treatment; Ischemia; Surgery; Digestive diseases; Technique
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/S0039-6060(96)80094-8

Background Reduction of operative blood transfusions is a primary goal in resective surgery of the liver. Temporary vascular inflow occlusion is an effective method to decrease hemorrhage during hepatic resection. This study was performed to assess the impact of normothermic ischemia on intraoperative bleeding and outcome after hepatic resection. Methods. Sixty-one hepatic resections were performed by using pedicle clamping alone or associated with total vascular exclusion of the liver. The mean duration of normothermic ischemia was 40±18 minutes (range, 7 to 98 minutes). Major resections were performed in 32 cases (52.5%). Results. Operative mortality was nil. Major complications occurred in 11.5% of cases. Twenty-five patients (41%) received intraoperative blood transfusions; mean ± SD of transfused blood units was 2.4±1.3. Twelve major resections (37.5%) did not require any transfusion. Postoperative changes in liver function test results were moderate and transient. Conclusions. The results of this study confirm the benefit of vascular occlusion techniques in reducing intraoperative bleeding and postoperative complications. The routine use of these techniques during hepatic resections, if applied properly and with the necessary precautions, is not associated with severe adverse effects on liver function.