150 HEPATIC RESECTIONS - EVOLUTION OF TECHNIQUE TOWARDS BLOODLESS SURGERY

A technique of hepatic resection is described and the results of 150 r esections are reviewed, Hepatic transection was performed, under inter mittent portal inflow occlusion, using ultrasonic aspiration to skelet onize portal branches and venous tributaries. Control of venous haemor rhage optimized by argon beam central venous pressure 0 and 4cmH(2)O b y extradural blockade nitroglycerine infusion. One patient with jaundi ce died in hospital, giving a mortality rate of 0.7 per cent, There we re no deaths in patients without jaundice and cirrhosis. Fifteen patie nts (10.0 per cent) had significant complications, nine medical and si x surgical, including three bile leaks (2.0 per cent). Mean blood loss was 814 ml for the whole study but only 434 ml in the last 4 years. D uring this latter period mean blood transfusion in hospital was 0.5 un its and mean postoperative haemoglobin value fell by 0.7 g per 100 ml. Hepatic resection can be performed with the same degree of confidence and similar low morbidity as any other major surgical procedure.