Document Detail


Liver Resection Without Pedicle Clamping: Feasibility and Need for "Salvage Clamping". Looking for the Right Clamping Policy. Analysis of 512 Consecutive Resections.
MedLine Citation:
PMID:  21809167     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Pedicle clamping during liver resection (LR) is debated. The purpose of this study is to validate non-clamping policy across a large series of LR and to evaluate the need for salvage clamping (SC) and its outcomes. METHODS: Five hundred twelve consecutive LR without initial pedicle clamping performed between 2004 and 2009 were analyzed. RESULTS: Among 512 LR (171 major hepatectomies), 90.2% were completed without clampage. Fifty (9.8%) required SC. Blood loss were higher in SC group (555 vs. 175 mL, p < 0.0001), while transfusion rate was not. No differences were observed in terms of mortality (0%/1.3%), morbidity (38%/38.3%), liver dysfunction (4%/3.7%), and renal dysfunction (0%/1.3%). Bile leak rate was increased in the SC group (20%/10.2%, p = 0.036). At multivariate analysis, three predictive factors of SC were identified: arterial hypertension (p = 0.007, SC rate = 13%), cirrhosis (p = 0.003, SC rate = 26%), and LR conducted along the right portal scissure (p = 0.010, SC rate = 32%). One protective factor was identified: LR confined to antero-lateral segments (Sg2-6, p = 0.001, SC rate = 2%). Extension of LR had no impact on need for SC. CONCLUSIONS: The majority of LR can be safely performed without clamping with excellent outcomes. SC is a safe procedure and does not worsen postoperative outcomes, except for bile leak rate. Clamping policy should be tailored to the type of LR and presence of cirrhosis.
Authors:
Luca Viganò; Syed A A Jaffary; Alessandro Ferrero; Nadia Russolillo; Serena Langella; Lorenzo Capussotti
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-2
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  -     ISSN:  1873-4626     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128, Turin, Italy, lvigano@ymail.com.
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