Preoperative left hepatic lobe devascularisation to minimize perioperative bleeding in a Jehovah’s Witness undergoing left hepatectomy

Abstract

HighlightsLiver resection in a Jehovah’s Witness patient requires multimodal blood minimization strategies to improve patient centred outcomes.Combination portal vein embolization and hepatic lobe revascularization for total vascular inflow occlusion can allow a bloodless resection.Preoperative angio-embolization should be researched in a larger patient cohort to reduce blood loss and blood transfusion

Safety and feasibility of elective liver resection in adult Jehovah's Witnesses: the Henri Mondor Hospital experience

“…34 Low central venous pressure was used for all patients and was mentioned in most of the reported patients. 1,[4][5][6][7][8] The efficiency of this technique has been extensively reported and does not need further comment. 35 Furthermore, clamping the inferior vena cava below the liver i) can decrease blood loss when central venous pressure <5 mmHg cannot be achieved, 36 and ii) more importantly, was shown in a recent controlled study to be even more efficacious for controlling bleeding during hepatectomy when combined with the Pringle maneuver than combined low central venous pressure and Pringle maneuver.…”

“…Devascularization of the future specimen with sequential PVE and arterial embolization before resection with the aim of decreasing operative bleeding was reported recently. 6 Despite Henri Mondor experience with laparoscopy 31 and robot-assisted laparoscopy 32 and the widely acknowledged decreased rate of transfusion/blood loss in laparoscopy compared with the open approach, it was only used in 2 patients in the current series. The reason was because it was considered that the rapid and definitive control of significant bleeding remains easier during open surgery than during laparoscopic surgery 33 .…”

“…Despite tremendous progress in the perioperative management of liver resection, reports of this procedure in JW patients remain scarce; all the existing studies are case reports and small case series. [1][2][3][4][5][6][7][8][9] Yet, blood transfusion rate remains far from zero, even in the most recent period (3.7% and 7.6% for minor and major resections respectively. 10 The aim of the present study was to report the Henri Mondor experience with liver resection in JWs and analyze it in terms of optimal management, feasibility and safety in light of current knowledge obtained through a systematic review of published studies.…”