VASCULAR INFLOW OCCLUSION FOR MAJOR HEPAT IC RESECTIONS - DE PRINCIPEOR NOT - A COMPARATIVE-STUDY

Fifty-two consecutive patients undergoing major hepatic resection for liver tumor. were divided into two groups according to the operative p rocedure. Group A consisted of 34 patients in whom vascular inflow occ lusion was performed ''de principe'' during parenchymal division and i ntrahepatic approach of the portal structures,. the mean duration of t he portal triad clamping was 43 mn (ranged 17 to 70 mn). Group B patie nts (18 cases) had hilar division of the structures of that portion of the liver due to be removed, prior to parenchymal division was perfor med without vascular arrest, except in five ''de necessitate'' cases d uring 5 to 22 mn. Groups A and B were comparable in terms of patient a ge or status, of king of liver tumors and extent of resection. Mean op erating duration (215 vs 263n mn) volume of intraoperative blood trans fusion (557 vs 1019 ml), intensive care (2.5 vs 4.2 days) and total ho spital stays (19.6 vs 30.5 days) were significantly reduced in group A . A higher but transient increase of amino-transferase level was the o nly biochemical consequence of liver ischemia in group A, whereas post operative disturbance in serum bilirubin, prothrombin time, fibrinogen , and total protein were significantly, greater in group B, probably b ecause of the greater volume of blood transfusion in this group. Thus, routine vascular inflow occlusion with transhepatic approach of the p ortal structures may be an effective and innocuous procedure for major liver resection.