Reduction of transfusion requirements during major hepatic resection for metastatic disease

Background. Our purpose was to determine whether the combination of total l iver vascular inflow occlusion (Pringle maneuver) and rapid hepatic transec tion with a clamp-crush technique results in significant reduction of blood loss and transfusion requirements during major hepatic resections. Methods. A series of 49 adult patients underwent major hepatic resections f or metastatic disease between April 1, 1992, and March 31, 1998. Group 1 pa tients (n = 15) had standard hilar dissection and finger-fracture haptic tr ansection without total liver inflow occlusion. Group 2 patients (n = 34) h ad total liver inflow occlusion and clamp-crush parenchymal transection. Results. Median blood loss was 1600 mL for group 1 and 500 mL for group 2 ( P = .001). Eleven (73%) patients in group 1 required intraoperative blood t ransfusion (median 2 units) compared with 7 (21%) in group 2 with a median of 0 units (P = .001 and P < .001, respectively). Of the 7 patients in grou p 2 who required transfusion, 3 had a preoperative hemoglobin below 10 g/dL , 1 required splenectomy for operative injury, and 1 underwent a concomitan t complicated small bowel resection. Conclusions. Major hepatic resections can be performed without transfusion of blood products when preoperative hemoglobin is above 10 g/dL and concomi tant major surgical procedures are not required.