Clinical results of hepatectomy without vascular clamping

Hwang, Dae Wook; Lee, Dong Shik; Yoon, Sung Su; Kim, Hong Jin

Abstract

PURPOSE: Portal triad clamping and total or intermittent hepatic vascular exclusion are usually used to reduce blood loss during a major liver resection. Here we report the results of hepatectomy without vascular clamping.
METHODS
From January 2003 to December 2005, 143 hepatectomies were performed without vascular clamping. There were 102 men and 41 women, with a mean age of 56.4 years. The indications were 79 hepatocellular carcinomas, 20 intrahepatic duct stones, 13 metastases, 13 gallbladder carcinomas, 7 intrahepatic cholangiocarcinomas, 5 Klatskin's tumors, and 6 others. All procedures were carried out using an ultrasonic dissector and intraoperative ultrasonography.
RESULTS
There were 11 complications (7%) including intra-abdominal abscess (3), hyperbilirubinemia (3), postoperative bleeding (2), hepatic failure (1), ARDS (Acute respiratory distress syndrome) (1), and massive ascites (1). Sixty-one patients (42.6%) required a blood transfusion. The mean blood transfusion requirement was 1.4 pints. The liver function test results were similar to those previously reported on days 1,3,5, and 7 postoperatively, with a return to normal values after 1 week.
CONCLUSIONS
Hepatectomy without vascular clamping reduces liver injuries, including ischemia of the remnant liver and splanchnic congestion. Reduction of bleeding during hepatectomy, requires accurate knowledge of the vascular anatomy, meticulous dissection of the liver parenchyma and maintenance of a low central venous pressure. Our experience with liver resections showed that hepatectomy without vascular clamping can be safely performed using intraoperative ultrasound and an ultrasonic dissector.