Major hepatic resection without blood transfusion: Experience with total vascular exclusion

Thirty consecutive, major liver resections performed with total vascular ex clusion in both non-cirrhotic and cirrhotic patients were analysed retrospe ctively. The patients' ages ranged from 6 months to 80 years. Ten were Asia ns and five had cirrhosis associated with chronic hepatitis B or C. There w as no perioperative death and the mean hospital stay was 6 days for adults and 9.2 days for children. The average vascular exclusion or warm ischaemia time was 25 min (range 10-55 min) and the average intraoperative blood vol ume given was 275 mt (range 0-3000 mt) packed red blood cells. Sixty per ce nt required no intraoperative blood transfusion. The mean total bilirubin a nd aspartate aminotransferase were 1.0 mg/dL (range 0.3-2.3 mg/dL) and 84 I U/L (range 14-306 IU/L) when measured prior to discharge at postoperative d ay 4-7. In our experience, total vascular exclusion is invaluable in major or difficult liver resections, especially lesions adjacent to the hepatic v eins and vena cava. It is associated with a low blood transfusion requireme nt and a low incidence of complications. It further obviates the need for d issection of the porta hepatis and its associated risks. Total vascular exc lusion time of 30 min appears to be well tolerated, even in patients with c ompensated cirrhosis.