Arkadopoulos N, Stafyla V, Marinis A, Koutoulidis V, Theodoraki K, Theodosopoulos T, Vassiliou I, Dafnios N, Fragulidis G, Smyrniotis V. Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases. World J Gastroenterol 2009; 15(3): 339-343 [PMID: 19140234 DOI: 10.3748/wjg.15.339]
Corresponding Author of This Article
Athanasios Marinis, MD, PhD, Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia’s Ave, 11528 Athens, Greece. sakisdoc@yahoo.com
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Nikolaos Arkadopoulos, Vaia Stafyla, Athanasios Marinis, Theodosios Theodosopoulos, Ioannis Vassiliou, Nikolaos Dafnios, Georgios Fragulidis, Vassilios Smyrniotis, Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia’s Ave, 11528 Athens, Greece
Kassiani Theodoraki, First Department of Anesthesiology, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia’s Ave, 11528 Athens, Greece
Vassilios Koutoulidis, First Department of Radiology, School of Medicine, University of Athens Aretaieion University Hospital, 76 Vassilisis Sofia’s Ave, 11528 Athens, Greece
Author contributions: Arkadopoulos N, Marinis A and Stafyla V wrote the paper; Theodosopoulos T, Vassiliou I and Smyrniotis V critically reviewed the manuscript; Koutoulidis V was responsible for the imaging studies; Fragulidis G, Dafnios N and Theodoraki K organized and reviewed the data collected for this study.
Correspondence to: Athanasios Marinis, MD, PhD, Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia’s Ave, 11528 Athens, Greece. sakisdoc@yahoo.com
Telephone: +30-210-7286157
Fax: +30-210-7286128
Received: July 11, 2008 Revised: December 11, 2008 Accepted: December 18, 2008 Published online: January 21, 2009
Abstract
AIM: To test whether clamping during liver surgery predisposes to hepatic vein thrombosis.
METHODS: We performed a retrospective analysis of 210 patients who underwent liver resection with simultaneous inflow and outflow occlusion. Intraoperatively, flow in the hepatic veins was assessed by Doppler ultrasonography during the reperfusion phase. Postoperatively, patency of the hepatic veins was assessed by contrast-enhanced CT angiography, when necessary after 3-6 mo follow up.
RESULTS: Twelve patients (5.7%) developed intraoperative liver remnant swelling. However, intraoperative ultrasonography did not reveal evidence of hepatic vein thrombosis. In three of these patients a kinking of the common trunk of the middle and left hepatic veins hindering outflow was recognized and was managed successfully by suturing the liver remnant to the diaphragm. Twenty three patients (10.9%) who developed signs of mild outflow obstruction postoperatively, had no evidence of thrombi in the hepatic veins or flow disturbances on ultrasonography and contrast-enhanced CT angiography, while hospitalized. Long term assessment of the patency of the hepatic veins over a 3-6 mo follow-up period did not reveal thrombi formation or clinical manifestations of outflow obstruction.
CONCLUSION: Extrahepatic dissection and clamping of the hepatic veins does not predispose to clinically important thrombosis.
