Application of Hemihepatic Vascular Occlusion with Hanging Maneuver in Hepatectomy

Division of Hepatobiliary Disease, Department of General Surgery Second Xiangya Hospital of Central South University, Changsha 410011, China.
Hepato-gastroenterology (Impact Factor: 0.93). 03/2009; 56(90):442-6.
Source: PubMed


To evaluate the hemihepatic vascular occlusion with hanging maneuver in hepatectomy.
Ninety-four cases of hepatectomy were analyzed retrospectively. All patients were randomized into 3 groups: Pringle maneuver was applied in Group 1 (n=40), hemihepatic inflow control was Group 2 (n=30) and complete hemihepatic vascular occlusion with hanging maneuver was applied in Group 3 (n=24).The clamping period, operation time, bleeding volume, blood transfusion volume, postoperative recovery of liver function and postoperative complications were compared among three groups.
The average times of clamping in Group 1 was 1.6 +/- 0.7, but only one clamping in Group 2 and 3. There were significant differences among three groups in bleeding volume as well. The postoperative serum ALT and total bilirubin (TBIL) in Group 2 and 3 were significantly lower than those of Group 1.5 patients died of liver failure after operation in Group 1. But liver failure or morbidity wasn't happened in Group 2 and 3. The rates of biliary leakage in Group 1 and 2 were more than that of Group 3. The hospitalization duration of Group 1 was significantly longer than those of Group 2 and 3.
Hemihepatic vascular occlusion with hanging maneuver, which can reduce bleeding volume and enhance the recovery of liver function, is safe and practicable, especially for patients with liver cirrhosis.

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    ABSTRACT: To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion (HHO) compared with total hepatic inflow occlusion (THO). Randomized controlled trials (RCTs) comparing hemihepatic vascular occlusion and total hepatic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta-analysis was conducted to estimate blood loss, transfusion requirement, and liver injury based on the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Either the fixed effects model or random effects model was used. Four RCTs including 338 patients met the predefined inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Meta-analysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean difference (WMD) 342.27; 95% confidence intervals (CI) 217.28-467.26; P = 0.00 001; I(2) = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7. Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections.
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    ABSTRACT: Background/Aims: To clarify the clinical benefits of the maneuver in right-side hepatectomy. Methodology: Eighty-one patients with liver tumor (54 hepatocellular carcinoma, 17 metastatic liver tumor and 10 other tumors) treated with a right-side hepatectomy were prospectively analyzed. The patients were divided into the following three groups: a conventional approach (group A, n=21); liver dissection under the hanging maneuver after liver mobilization (group B, n=19) and liver dissection under the hanging maneuver prior to liver mobilization (group C, n=41). Results: The liver hanging maneuver was safely performed in all the patients in groups B and C. Tumor size had a significantly positive correlation with the amount of intraoperative blood loss (R=0.52, p<0.05) in group A only. The patients in groups B and C had a significantly lower intraoperative use of blood loss (both p<0.01), operation time (p<0.05 and p<0.01) and the frequency of blood product (both p<0.05), in comparison to group A, respectively. The postoperative morbidity and the mortality rates were similar in the three groups. Conclusions: Liver hanging maneuver is a safe procedure, which can decrease intraoperative blood loss and administration of blood product in right-side hepatectomy.
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