Selective and unselective clamping in cirrhotic liver.

BACKGROUND/AIMS: Liver surgery requires a reduction of the operative blood loss especially for patients with cirrhosis. Selective or unselective liver clamping during hepatic resection is performed to minimize the surgical risk for such compromised patients.

METHODOLOGY

We carried out elective hepatic resection in 158 patients with the use of total hilar clamping (Pringle's manoeuvre) or selective vascular clamping (Makuuchi's manoeuvre). The clinical outcomes were evaluated according to the clamping method and the condition of background liver.

RESULTS

Pringle's manoeuvre was used in 132 patients who underwent all types of hepatectomy, whereas Makuuchi's manoeuvre was applied selectively to 26 patients, most of whom underwent segmentectomy or subsegmentectomy. A modified Makuuchi's manoeuvre was used in eight healthy donors who underwent left-sided hepatectomy for transplantation. The cumulative clamping times and blood losses were 61 +/- 47 min (mean +/- SD) and 831 +/- 716 ml in the Pringle's manoeuvre group, and 95 +/- 47 min and 1.035 +/- 577 ml in the Makuuchi's manoeuvre group. In patients with normal hepatic parenchyma the longest clamping time was 322 min, and in those with cirrhosis it was 202 min. All the patients in this series tolerated vascular clamping well, and their hepatic functional parameters returned, regardless of the presence or absence of cirrhosis, to the baseline levels within a week. As a whole, the operative morbidity and mortality rates were 20.3% and 0%, respectively.

CONCLUSIONS

Intermittent total or selective clamping can be an indispensable procedure during hepatic resection for all patients, irrespective of the degree of hepatic dysfunction, to improve safety and resectability.