Total versus selective hepatic vascular exclusion in major liver resections

Background: Total hepatic vascular exclusion (THVE) and selective hepatic vascular exclusion (SHVE) are two effective techniques for bleeding control in major hepatic resections. Outcomes of the two procedures were compared. Methods: Patients undergoing major liver resection were randomly allocated...

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Bibliographic Details
Published in:	The American journal of surgery Vol. 183; no. 2; pp. 173 - 178
Main Authors:	Smyrniotis, Vassilios E, Kostopanagiotou, Georgia G, Gamaletsos, Evangelos L, Vassiliou, John G, Voros, Dionisios C, Fotopoulos, Alexis C, Contis, John C
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-02-2002 Elsevier Elsevier Limited
Subjects:	Adolescent Adult Aged Biological and medical sciences Bleeding Blood loss surgical/prevention and control Blood Loss, Surgical - prevention & control Blood transfusions Chi-Square Distribution Child Child, Preschool Complications Creatinine Cross-Over Studies Female Gastroenterology. Liver. Pancreas. Abdomen Hemodynamics Hepatectomy - methods Humans Infant Ischemia Liver Liver - blood supply Liver diseases Liver surgery Liver, biliary tract, pancreas, portal circulation, spleen Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Patients Postoperative Postoperative complications Prospective randomized trial Prospective Studies Pulmonary arteries Renal function Shunt resistance Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Thoracic surgery Treatment Outcome Tumors Ultrasonic imaging Vascular occlusion Veins & arteries Blood loss surgical/prevention and control Liver surgery Vascular occlusion Postoperative complications Prospective randomized trial Hepatectomy/methods Human Liver Check Cardiovascular disease Hepatic disease Hepatocellular carcinoma Surgical resection Malignant tumor Abdominal blood vessel disease Hemorrhage Result Prospective Prevention Treatment Surgery Digestive diseases Lesion Technique Comparative study
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Summary:	Background: Total hepatic vascular exclusion (THVE) and selective hepatic vascular exclusion (SHVE) are two effective techniques for bleeding control in major hepatic resections. Outcomes of the two procedures were compared. Methods: Patients undergoing major liver resection were randomly allocated to the THVE and SHVE groups. Intraoperative hemodynamic changes and the postoperative course of the two groups were compared. Results: During vascular clamping, the THVE group showed a significant elevation in pulmonary vascular resistance, systemic vascular resistance, intrapulmonary shunts, and a significant reduction in cardiac index, compared with the SHVE group ( P <0.05). Patients undergoing THVE received more crystalloids and blood, showed more severe liver, renal and pancreatic dysfunction, and had a longer hospital stay than the SHVE group ( P <0.05). Conclusions: Both techniques are equally effective in bleeding control in major liver resections. THVE is associated with cardiorespiratory and hemodynamic alterations and may be not tolerated by some patients. SHVE is well tolerated with fewer postoperative complications and shorter hospitalization time.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0002-9610 1879-1883
DOI:	10.1016/S0002-9610(01)00864-9