The introduction of a simple maneuver to reduce the risk of postoperative bleeding after major hepatectomies |
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Authors: | Ioannis Vassiliou Nikolaos Arkadopoulos Vaia Stafyla Kassiani Theodoraki Anneza Yiallourou Theodosios Theodosopoulos George Kotis George Fragoulidis Thomas Kotsis and Vassilios Smyrniotis |
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Institution: | (1) 2nd Department of Surgery, Athens University Medical School, Aretaieion Hospital, 76 Vasilissis Sofias Avenue, 11528 Athens, Greece;(2) 1st Department of Anesthesiology, Athens University Medical School, Aretaieion Hospital, 76 Vasilissis Sofias Avenue, 11528 Athens, Greece;(3) 22 Chanioti Street, 15452 Athens, Greece |
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Abstract: | Background/Purpose In major hepatectomies, postoperative increases in central venous pressure (CVP) may cause suture failure and massive bleeding.
The aim of our study is to test the application of an intraoperative maneuver to reduce the risk of postoperative bleeding.
Methods Our study included 172 consecutive patients who had major liver resection with selective hepatic vascular exclusion and sharp
transection of the liver parenchyma. An intraoperative maneuver (5 s occlusion of the hepatic vein) was applied in an alternating
way, and the patients were assigned to two groups: Cohort A (n = 86), that was granted the maneuver, and Cohort B (n = 86), that was used as a control group.
Results In Cohort A, application of the maneuver was successful in demonstrating bleeders under low CVP levels. Cohort A had lower
rate of massive bleeding requiring emergency reoperation (2.3 vs 5.8%, P = 0.049), less postoperative blood transfusions (13 vs 24%, P = 0.042), lower morbidity (20 vs 35%, P < 0.045) and shorter hospital stay compared to Cohort B.
Conclusions Hepatectomies conducted under low CVP are prone to postoperative hemorrhage which can be prevented if the final bleeding control
is performed under high pressure in the hepatic veins. Application of our testing maneuver effectively unmasked previously
undetectable bleeding veins. |
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Keywords: | Central venous pressure Pringle maneuver Hepatic veins Inferior vena cava Liver ischemia |
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