• Si-Yuan Fu, F U Si-Yuan, Wan-Yee Lau, Lau Wan Yee, Guang-Gang Li, Li Guang-Gang, Qing-He Tang, Tang Qing-He, Ai-Jun Li, L I Ai-Jun, Ze-Ya Pan, P A N Ze-Ya, Gang Huang, Huang Gang, Lei Yin, Yin Lei, Meng-Chao Wu, W U Meng-Chao, Eric C H Lai, L A I Eric, Wei-Ping Zhou, and Zhou Wei-Ping.
• The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
• Am. J. Surg. 2011 Jan 1; 201 (1): 62-9.

Backgroundblood loss during liver resection and the need for perioperative blood transfusions have negative impact on perioperative morbidity, mortality, and long-term outcomes.Methodsa randomized controlled trial was performed on patients undergoing liver resection comparing hemihepatic vascular inflow occlusion, main portal vein inflow occlusion, and Pringle maneuver. The primary endpoints were intraoperative blood loss and postoperative liver injury. The secondary outcomes were operating time, morbidity, and mortality.Resultsa total of 180 patients were randomized into 3 groups according to the technique used for inflow occlusion during hepatectomy: the hemihepatic vascular inflow occlusion group (n = 60), the main portal vein inflow occlusion group (n = 60), and the Pringle maneuver group (n = 60). Only 1 patient in the hemihepatic vascular occlusion group required conversion to the Pringle maneuver because of technical difficulty. The Pringle maneuver group showed a significantly shorter operating time. There were no significant differences between the 3 groups in intraoperative blood loss and perioperative mortality. The degree of postoperative liver injury and complication rates were significantly higher in the Pringle maneuver group, resulting in a significantly longer hospital stay.Conclusionsall 3 vascular inflow occlusion techniques were safe and efficacious in reducing blood loss. Patients subjected to hemihepatic vascular inflow occlusion, or main portal vein inflow occlusion responded better than those with Pringle maneuver in terms of earlier recovery of postoperative liver function. As hemihepatic vascular inflow occlusion was technically easier than main portal vein inflow occlusion, it is recommended.2011 Elsevier Inc. All rights reserved.

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