One hundred and fifty hepatic resections: Evolution of technique towards bloodless surgery

Abstract

A technique of hepatic resection is described and the results of 150 resections are reviewed. Hepatic transection was performed, under intermittent portal inflow occlusion, using ultrasonic aspiration to skeletonize portal branches and venous tributaries. Control of venous haemorrhage during resection was optimized by argon beam coagulation and lowering central venous pressure to between 0 and 4 cmH2O by extradural blockade and systemic nitroglycerine infusion. One patient with jaundice died in hospital, giving a mortality rate of 0.7 per cent. There were no deaths in patients without jaundice and cirrhosis. Fifteen patients (10.0 per cent) had significant complications, nine medical and six surgical, including three bile leaks (2.0 per cent). Mean blood loss was 814 ml for the whole study but only 434 ml in the last 4 years. During this latter period mean blood transfusion in hospital was 0.5 units and mean postoperative haemoglobin value fell by 0.7 g per 100 ml. Hepatic resection can be performed with the same degree of confidence and similar low morbidity as any other major surgical procedure.

Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease

“…Univariate analyses in the present study revealed that blood loss and the need for transfusion were influenced by almost the same factors as those reported by others 2,22,26,27 . Some studies 21,28,29 have shown that maintenance of a low CVP is effective in reducing blood loss in hepatectomy. However, most of or all of the patients in these studies had no underlying liver disease.…”

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

“…9 In addition, bleeding and blood transfusion are risk factors for postoperative morbidity and in some reports, long-term cancer recurrence. 6,[10][11][12][13][14][15][16][17][18][19][20][21][22] Furthermore, blood products are sometimes scarce and associated with appreciable expense. Thus, there is compelling rationale to reduce blood loss and blood transfusion as much as possible in patients undergoing liver resection.…”

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

“…Other anesthetic maneuvers helpful in reducing blood loss during liver resections include volume restriction prior to specimen resection, reverse Trendelenburg position, epidural analgesia, and systemic infusion of nitroglycerin. Using a combination of epidural blockade and systemic nitroglycerine infusion, Rees et al reported a perioperative morbidity and mortality of 10% and 0.7%, respectively [111]. Antifibrinolytics have also been used to decrease blood loss and transfusion during liver surgery, but results have been controversial [13].…”