B. Malassagne et al., SAFETY OF SELECTIVE VASCULAR CLAMPING FOR MAJOR HEPATECTOMIES, Journal of the American College of Surgeons, 187(5), 1998, pp. 482-486
Background: Although hepatic vascular clampings are widely used during
major hepatic resections, they may not always be necessary. Selective
vascular clamping, which only controls the afferent blood flow of the
resected liver, could be a valuable alternative, provided that blood
loss is not increased because the opposite liver remains perfused. Stu
dy Design: The aim of the study was to assess the safety of selective
vascular clamping in 43 patients who underwent 36 right hepatectomies
and 7 left hepatectomies for lesions located peripherally within the l
iver Blood transfusions, hepatic tests, morbidity, mortality, and hosp
ital stay were evaluated. Results: Selective vascular clamping was eff
icient in 34 of the 43 attempts (79%), but bleeding from the contralat
eral liver required conversion to portal triad clamping in 9 patients
(21%), Median blood transfusions were 0 units (range 0 to 4 U), and 28
patients (65%) did not require transfusions. Postoperative laboratory
tests showed that larger changes occurred at day 1 and tended to retu
rn to preoperative values at the end of the first postoperative week.
Median time of hospitalization was 10 days (range 7 to 28 days). Posto
perative course was uneventful in 35 patients (81%). Nonlethal complic
ations occurred in 7 patients (16.3%). One patient (2%) with massive h
epatic steatosis died of liver failure after right hepatectomy. Conclu
sions: Selective vascular clamping is a safe alternative to total infl
ow occlusion for major hepatectomies applicable in 80% of selected pat
ients with peripheral liver tumors. (J Am Cell Surg 1998;187:482-486.
(C) 1998 by the American College of Surgeons).