Application of Right Hemihepatic Vascular Exclusion in Liver Resection

Lee, Dong Shik; Son, Jae Ho; Kim, Se Won; Yoon, Sung Su; Kim, Hong Jin

Abstract

PURPOSE
Control of bleeding and preservation of liver function are still major keys for successful liver resection. We applied right hemihepatic vascular exclusion (RHVE) in patients with a right lobe liver tumor to verify the usefulness and safety of RHVE. METHODS: Between March 1998 and August 2002, 12 patients (Control group) underwent right liver surgeries without inflow occlusion, and 22 patients (RHVE group) underwent right liver surgeries under RHVE. Hemodynamic changes during the operation, amount of transfusion, and post- operative liver function were compared between the two groups. RESULTS: The mean duration of RHVE was 32.3+/-13.9 (15~60) minutes. The mean arterial pressure of the control group and the RHVE group after liver resection were reduced, but these changes were not statistically significant. The amount of transfusion in the RHVE group (2.66+/-1.4 unit) was significantly lower (P<0.05) than that of the control group (4.56+/-3.3 unit). AST/ALT level of the RHVE group were significantly higher on POD#1, but there were no statistically significant differences on POD#3, 5 and 7. Also, the differences in the changes of total bilirubin and IL-6 after liver resection were not significant. Cirrhotic patients in both groups were compared with the same analysis. Only the amounts of transfusion in the RHVE group were significantly lower (P<0.05) than that of the control group. CONCLUSION: RHVE is a safe and useful procedure for right liver surgery with minimal blood loss, but without significant hemodynamic alteration and functional deterioration. These characteristics are shown especially in cirrhotic liver and non-anatomical resection of metastatic cancer.