101. Right hepatectomy with extra-hepatic vascular division prior to transection: intention-to-treat analysis of a standardized policy.
- Author
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Boleslawski E, Decanter G, Truant S, Bouras AF, Sulaberidze L, Oberlin O, and Pruvot FR
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Loss, Surgical prevention & control, Blood Transfusion, Chi-Square Distribution, Feasibility Studies, Female, Hepatectomy adverse effects, Hepatectomy mortality, Hepatectomy standards, Hepatic Artery surgery, Hepatic Veins surgery, Humans, Intention to Treat Analysis, Liver Failure etiology, Liver Failure mortality, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Portal Vein surgery, Quality of Health Care standards, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures mortality, Vascular Surgical Procedures standards, Young Adult, Hepatectomy methods, Liver blood supply, Liver surgery, Vascular Surgical Procedures methods
- Abstract
Background: Right hepatectomy (RH) is the most common type of major hepatectomy and can be achieved without portal triad clamping (PTC) in non-cirrhotic liver. The present study reviews our standardized policy of performing RH without systematic PTC., Methods: One hundred and eighty-one consecutive RH were performed in non-cirrhotic patients, with division of the right afferent and efferent blood vessels prior to transection, without systematically using PTC. Prospectively collected data were analysed, focusing on the following endpoints: need for salvage PTC, ischaemic time, blood loss and post-operative outcome., Results: Extra-hepatic division of the right hepatic vessels was feasible in all patients, but was ineffective in 48 patients (26.5%) who required salvage PTC during transection. In those patients, the median ischaemic time was 20 min. The median blood loss was 500 ml (50-3000). Six patients (3.3%) experienced post-operative liver failure. Overall morbidity, severe morbidity and mortality were 42%, 12.1% and 1.6%, respectively, with peri-operative transfusion rate (16.6%) being the only factor associated with morbidity., Discussion: By performing RH with extra-hepatic vascular division prior to transection, PTC can be safely avoided in the majority of patients., (© 2012 International Hepato-Pancreato-Biliary Association.)
- Published
- 2012
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