Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 28, 2016; 8(24): 1038-1046
Published online Aug 28, 2016. doi: 10.4254/wjh.v8.i24.1038
Liver resections can be performed safely without Pringle maneuver: A prospective study
Christoph A Maurer, Mikolaj Walensi, Samuel A Käser, Beat M Künzli, René Lötscher, Anne Zuse
Christoph A Maurer, Department of Surgery, Hirslanden-Clinic Beau-Site, 3013 Bern, Switzerland
Christoph A Maurer, Mikolaj Walensi, Samuel A Käser, Beat M Künzli, Anne Zuse, Department of Surgery, Hospital of Baselland, Affiliated with the University of Basel, 4410 Liestal, Switzerland
Samuel A Käser, Department of Visceral and Transplant Surgery, Rämistrasse 100, 8091 Zurich, Switzerland
René Lötscher, Department of Anesthesia and Intensive Care, Hospital of Baselland, Affiliated with the University of Basel, 4410 Liestal, Switzerland
Author contributions: Maurer CA made the conception and design of the study; Maurer CA, Walensi M, Käser SA, Künzli BM and Lötscher R acquired the data; Maurer CA, Künzli BM and Zuse A analyzed the data; Maurer CA, Walensi M, Käser SA, Künzli BM, Lötscher R and Zuse A did the interpretation of the data; Maurer CA, Künzli BM and Zuse A drafted the manuscript; Maurer CA, Walensi M, Käser SA, Künzli BM, Lötscher R and Zuse A revised and approved the final version of the manuscript.
Institutional review board statement: The study was approved by the ethical committee of Basel and Baselland (EKBB No. 188/13).
Informed consent statement: All patients gave their informed consent for surgery prior to study inclusion.
Conflict-of-interest statement: Nothing to declare. No potential or real conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christoph A Maurer, MD, FACS, FRCS (Hon.), FEBS, Professor of Surgery, Department of Surgery, Hirslanden-Clinic Beau-Site, Schänzlihalde 1, CH-3000 Bern-25, 3013 Bern, Switzerland. christoph.maurer@hin.ch
Telephone: +41-32-6215113 Fax: +41-32-6215112
Received: March 20, 2016
Peer-review started: March 23, 2016
First decision: April 20, 2016
Revised: May 4, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: August 28, 2016
Processing time: 158 Days and 4.9 Hours
Abstract
AIM

To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad.

METHODS

Between 9/2002 and 7/2013, 175 consecutive liver resections (n = 101 major anatomical and n = 74 large atypical > 5 cm) without Pringle maneuver were performed in 127 patients (143 surgeries). Accompanying, 37 wedge resections (specimens < 5 cm) and 43 radiofrequency ablations were performed. Preoperative volumetric calculation of the liver remnant preceeded all anatomical resections. The liver parenchyma was dissected by water-jet. The median central venous pressure was 4 mmHg (range: 5-14). Data was collected prospectively.

RESULTS

The median age of patients was 60 years (range: 16-85). Preoperative chemotherapy was used in 70 cases (49.0%). Liver cirrhosis was present in 6.3%, and liver steatosis of ≥ 10% in 28.0%. Blood loss was median 400 mL (range 50-5000 mL). Perioperative blood transfusions were given in 22/143 procedures (15%). The median weight of anatomically resected liver specimens was 525 g (range: 51-1850 g). One patient died postoperatively. Biliary leakages (n = 5) were treated conservatively. Temporary liver failure occurred in two patients.

CONCLUSION

Major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay.

Keywords: Liver resection; Pringle maneuver; Blood loss

Core tip: This retrospective cohort study on 175 consecutive liver resections (n = 101 major anatomical and n = 74 large atypical > 5 cm) shows that major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay.