HEPATIC RESECTION UNDER THE INTERMITTENT SELECTIVE PORTAL BRANCH OCCLUSION BY BALLOON CATHETER

BACKGROUND: In hepatic resection, it is important to control intrahepa tic blood flow to minimize blood loss. Intermittent and selective vasc ular occlusion, if possible, are advisable. STUDY DESIGN: For this pur pose, we created the double balloon catheter, which when introduced in to a lobar or a smaller branch of the intrahepatic portal vein through a branch of the ileocolic vein, made it possible to occlude these bra nches temporarily during hepatic resection. The small balloon located at the tip of the catheter made it easy to introduce the catheter to t he portal branch selectively, under the guidance of ultrasonography. A nother balloon was inflated intermittently to occlude selective portal blood flow. Using this technique, hepatic resection was achieved in 1 8 consecutive patients: 13 with hepatocellular carcinomas (11 with cir rhosis, two with chronic hepatitis), one with cholangiocellular carcin oma, three with metastatic carcinomas, and one with intrahepatic calcu li. RESULTS: In these cases, 19 hepatic resections were performed; two left hepatectomies, one extended right hepatectomy, one right hepatec tomy, six segmentectomies, eight subsegmentectomies, and one partial h epatectomy. In each case, well demarcated hepatic tissue delineated by ischemic change was removed with minimal bleeding and little impairme nt to the residual hepatic tissue, resulting in a good postoperative c ourse. CONCLUSIONS: This double balloon catheter can replace the disse ction of the hepatoduodenal ligament for hepatic resection, which caus es bleeding; especially in patients with cirrhosis, and results in les s cell injury of the residual hepatic parenchyma.