LIVER RESECTION WITH NORMOTHERMIC ISCHEMIA EXCEEDING 1-H

A retrospective study was made of 34 patients who underwent major live r resection with a single period of vascular occlusion exceeding 60 mi n. The liver remnant was normal in all cases. Vascular occlusion was a chieved hy continuous portal triad clamping (15 patients), hepatic vas cular exclusion (15) or a sequential combination of both procedures (f our). Liver cooling was not used. The mean(s.e.m.) duration of continu ous normothermic liver ischaemia was 73.6(2.5) (range 60-127) min. The mean(s.e.m.) amount of blood transfused during operation was 5.3(0.8) units packed red cells. There were no deaths after surgery and the po stoperative course was uneventful, or limited to asymptomatic pleural effusion, in 18 patients. Three patients suffered postoperative bleedi ng necessitating further surgery and one of these required reintervent ion for a prolonged bile leak. Four patients had transient liver failu re that resolved spontaneously within 15 days. There was a 13-fold inc rease in serum transaminase activities and the proaccelerin level was 45 per cent that of normal on day 1 after operation. These changes wer e returning to normal levels within 15 days. Continuous vascular occlu sion during major liver resection is a useful manoeuvre that may be pe rformed safely on normal hepatic parenchyma for up to 90 min.