SELECTIVE AND UNSELECTIVE CLAMPING IN CIRRHOTIC LIVER

BACKGROUND/AIMS: Liver surgery requires a reduction of the operative b lood loss especially for patients with cirrhosis. Selective or unselec tive liver clamping during hepatic resection is performed to minimize the surgical risk for such compromised patients. METHODOLOGY: We carri ed out elective hepatic resection in 158 patients with the use of tota l hilar clamping (Pringle's manoeuvre) or selective vascular clamping (Makuuchi's manoeuvre). The clinical outcomes were evaluated according to the clamping method and the condition of background liver. RESULTS : Pringle's manoeuvre was used in 132 patients who underwent all types of hepatectomy, whereas Makuuchi's manoeuvre was applied selectively to 26 patients, most of whom underwent segmentectomy or subsegmentecto my. A modified Makuuchi's manoeuvre was used in eight healthy donors w ho underwent left-sided hepatectomy for transplantation. The cumulativ e clamping times and blood losses were 61+/-47 min (mean +/-SD) and 83 1+/-716 ml in the Pringle's manoeuvre group, and 95+/-47 min and 1.035 +/-577 ml in the Makuuchi's manoeuvre group. In patients with normal h epatic parenchyma the longest clamping time was 322 min, and in those with cirrhosis it was 202 min. All the patients in this series tolerat ed vascular clamping well, and their hepatic functional parameters ret urned, regardless of the presence or absence of cirrhosis, to the base line levels within a week. As a whole, the operative morbidity and mor tality rates were 20.3% and 0%, respectively. CONCLUSIONS: Intermitten t total or selective clamping can be an indispensable procedure during hepatic resection for all patients, irrespective of the degree of hep atic dysfunction, to improve safety and resectability.