100 CONSECUTIVE HEPATIC RESECTIONS - BLOOD-LOSS, TRANSFUSION, AND OPERATIVE TECHNIQUE

Background: Hepatic resection is prone to significant blood loss. Adve rse effects of blood loss and transfusion mandate improvements in surg ical techniques to reduce blood loss and transfusion requirements. Met hods: One hundred hepatic resections were carried out using a standard surgical technique that includes control of the hilar structures, ext rahepatic control of the hepatic veins, and use of the Pringle maneuve r. Low central venous pressure and Trendelenburg positioning were used during parenchymal transection. Data were collected retrospectively i n the first 36 patients, whereas data were collected prospectively in the remaining 64 patients. Results: Hospital mortality was 3%. Median blood loss was 450, 700, 1000, 1100, and 1500 mt for segmental, nonana tomic, lobar, extended right, and extended left resections, respective ly. Major resections were more likely than minor resections to be tran sfused with albumin (P=.008), fresh frozen plasma (P=.009), and packed red blood cells or whole blood (P=.04). Overall transfusion of packed red blood cells or whole blood occurred in 59 of 100 patients. In the 64 patients who were followed up prospectively, the predeposit of aut ologous blood decreased the need for homologous transfusions from 56% to 38%. A further reduction in the transfusion rate to 25% could have been possible if all patients in the prospective group had donated 2 U of autologous blood. Patients who predeposited blood were more likely to receive transfusions and to have had a transfusion more than 24 ho urs after surgery than were patients who did not donate blood. Conclus ions: The surgical techniques used result in acceptable blood loss and transfusion requirements for hepatic resection. This approach is safe , cost-effective, reproducible, and applicable for widespread use.