Simplified hepatic resection with the use of prolonged vascular inflow occlusion.

Ten consecutive patients scheduled to undergo liver resection were studied prospectively with the use of a standard protocol, which included routine vascular inflow occlusion to reduce blood loss and blood transfusion requirements. Fibrin sealant was sprayed on the raw liver surface, and abdominal drainage was not performed. No deaths occurred, and the postoperative course was remarkably smooth. The normothermic liver ischemic times of 30 to 122 minutes (mean, 73 minutes) were well tolerated. The amount of blood transfused was reduced to a mean of 2 U (range, 0 to 4 U). The occurrence of infected intraabdominal bile collections in two patients with preexisting biliary tract infection suggested that abdominal drainage should be performed in such patients. Vascular inflow occlusion is recommended for all liver resections.