SAFETY OF SELECTIVE VASCULAR CLAMPING FOR MAJOR HEPATECTOMIES

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).