HEPATIC RESECTION WITH VASCULAR ISOLATION AND ROUTINE SUPRACELIAC AORTIC CLAMPING

BACKGROUND: Hepatic resection with total vascular isolation has been r eported to reduce hemorrhage. Addition of supraceliac aortic clamping putatively avoids hemodynamic instability, but may increase morbidity. METHODS: This technique was used in 99 major liver resections utilizi ng scalpel division and suture hemostasis. RESULTS: Livers were normal in 86 patients, cirrhotic with no portal hypertension in 5, and cirrh otic with portal hypertension in 8. There was 1 death in 91 patients w ith no portal hypertension compared with 5 in 8 patients with portal h ypertension due to hepatic failure or bleeding esophageal varices. The re 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. CONCLUSIONS: Use of total hepatic vascular isolation with routine supraceliac aorti c clamping is a safe and expedient method of hepatic resection that li mits blood loss and maintains hemodynamic stability, but does not incr ease morbidity. However, the presence of portal hypertension precludes safe resection.