HEPATIC RESECTIONS IN NORMOTHERMIC ISCHEMIA

Background. Reduction of operative blood transfusions is a primary goa l in resective surgery of the liver. Temporary vascular inflow occlusi on is an effective method to decrease hemorrhage during hepatic resect ion. This study was performed to assess the impact of normothermic isc hemia on intraoperative bleeding and outcome after hepatic resection. Methods, Sixty-one hepatic resections were performed bq using pedicle clamping alone or associated with total vascular exclusion of the live r. The mean duration of normothermic ischemia was 40 +/- 18 minutes (r ange, 7 to 98 minutes). Major resections were performed in 32 cases (5 2.5%). Results, Operative mortality was nil. Major complications occur red in 11.5% of cases. Twenty-five patients (41%) received intraoperat ive blood transfusions; mean +/- SD of transfused blood units was 2.4 +/- 1.3. Twelve major resections (37.5%) did not require any transfusi on. Postoperative changes in liver function test results were moderate and transient. Conclusions, The results of this study confirm the ben efit of vascular occlusion techniques in reducing intraoperative bleed ing and postoperative complications. The routine use of these techniqu es during hepatic resections, if applied properly and with the necessa ry, precautions, is not associated with severe adverse effects on live r function.