Hepatic resection with vascular isolation and routine supraceliac aortic clamping

Hepatic resection with total vascular isolation has been reported to reduce hemorrhage. Addition of supraceliac aortic clamping putatively avoids hemodynamic instability, bdbut may increase morbidity. This technique was used in 99 major liver resections utilizing scalpel division and suture hemostas...

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Bibliographic Details
Published in:The American journal of surgery 1996-03, Vol.171 (3), p.351-355
Main Authors: Stephen, Michael S., James Gallagher, P., Ross Sheil, A.G., Sheldon, Donald M., Storey, David W.
Format: Article
Language:English
Subjects:
Adult
Aged
Aorta
Aorta, Abdominal
Biological and medical sciences
Blood
Blood Loss, Surgical - prevention & control
Clamping
Constriction
Female
Hemodynamics
Hemorrhage
Hemostasis
Hemostatics
Hepatectomy - methods
Humans
Hypertension
Hypertension, Portal - etiology
Liver
Liver - blood supply
Liver - surgery
Liver Cirrhosis - complications
Liver Cirrhosis - surgery
Liver Diseases - surgery
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Middle Aged
Morbidity
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
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Summary:Hepatic resection with total vascular isolation has been reported to reduce hemorrhage. Addition of supraceliac aortic clamping putatively avoids hemodynamic instability, bdbut may increase morbidity. This technique was used in 99 major liver resections utilizing scalpel division and suture hemostasis. Livers were normal in 86 patients, cirrhotic with no portal hypertension in 5, and cirrhotic with portal hypertension in 8. There was 1 death in 91 patients with no portal hypertension compared with 5 in 8 patients with portal hypertension due to hepatic failure or bleeding esophageal varices. There were 59 hemihepatectomies and 40 segmentectomies. Median operating time was 145 and 110 minutes, respectively, and mean transfused blood was 4 and 0 units, respectively, with minimal morbidity. Use of total hepatic vascular isolation with routine supraceliac aortic clamping is a safe and expedient method of hepatic resection that limits blood loss and maintains hemodynamic stability, but does not increase morbidity. However, the presence of portal hypertension precludes safe resection.
ISSN:0002-9610
1879-1883
DOI:10.1016/S0002-9610(97)89640-7