Blood Loss Minimization in Liver Surgery

Česká verzia

Authors: J. Mendl; M. Oliverius; Valsamis A. Krak M. ^*
Authors place of work: Klinika transplantační chirurgie IKEM, přednosta: prof. MUDr. Miloš Adamec, CSc. ; Klinika anesteziologie, resuscitace a intenzivní péče IKEM, přednostka: MUDr. Eva Kieslichová ^*
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 7, s. 373-376.
Category: Monothematic special - Original

Summary

Introduction:
Liver procedures may be associated with severe blood loss, requiring administration of blood products. Severe bleeding prolongs resection time and has negative effects on morbidity and mortality rates. Any technique, which would reduce blood loss during resection procedures is beneficial for a patient, as well as for a surgeon.

Material and Methodology:
Literature overview of the commonest resection techniques and intraoperative care aimed at blood loss minimization. Assessment of the author’s study group of 183 patients, operated during 2004–2008.

Results and Conclusion:
During the study period, 217 liver resections were performed in 183 subjects. The mortality rate was 2.7%, the morbidity rate 24.6%. In none of the subjects, surgical revision was required for postoperative bleeding. The mean blood loss was 820 ml. When saving surgical techniques and modern devices are used, and high quality intraoperative and postoperative care is provided, the liver resections can be performed with minimum blood loss, resulting in fast reconvalescence and minimal complications.

Key words:
liver resection –blood loss

Zdroje

1. Nuzzo, G., Giuliante, F., Ardito, F., Vellone, M., Giovannini, I., Federico, B., Vecchio Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience. Surgery, 2008; 143(3): 384–393.

2. Chen, et al. Hepatic Resection Using Intermittent Vascular Inflow Occlusion and Low Central Venouš Pressure Anesthesia Improves Morbidity and Mortality. Journal of Gastrointestinal Surgery, Vol. 4, No. 2, 2000.

3. Jones, R. Mc L., Molton, C. E., Hardy, K. J. Central venous pressure and its effect on blood loss during liver resection. British Journal of Surgery, 1998, 85, 1058–1060.

4. Melendez, et al. Perioperative Outcomes of Major Hepatic Resections under Low Central Venous Pressure Anesthesia: Blood Loss, Blood Transfusion, and the Risk of Postoperative Renal Dysfunction. J. Am. Coll. Surg., 1998; 187: 620–625.

5. Smyrniotis, V., et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections. The American Journal of Surgery, 187 (2004), 398–402.

6. Wang, W. D., Liang, L. J., Huang, X. Q., Yin, X. Y. Low central venous pressure reduces blood loss in hepatectomy. World J. Gastroenterol., 2006; 12(6): 935–939.

7. Pringle, J. H. Notes on the arrest of hepatic haemorrhage due to trauma. Ann. Surg., 1909; 48: 541–549.

8. Adson, M. A., VanHeerden, J. A. Major hepatic resections for metastatic colorectal cancer. Ann. Surg., 1980; 191: 576–583.

9. Iwatsuki, S., Shaw, B. W., Starzl, T. E. Experience with 150 liver resections. Ann. Surg., 1983; 197: 247–253.

10. Sitzmann, J. V., Greene, P. S. Perioperative predictors of morbidity following hepatic resection for neoplasm: a multivariate analysis of a single surgeon experience with 105 patients. Ann. Surg., 1994; 219: 13–17.

11. Belghiti, J., Hiramatsu, K., Benoist, S., et al. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J. Am. Coll. Surg., 2000; 191: 38–46.

12. Sophia Virani, B. S., et al. Morbidity and Mortality after Liver Resection: Results of the Patient Safety in Surgery Study. J. Am. Coll. Surg., 2007; 204: 1284–1292.

13. Way, L. W. Současná chirurgická diagnostika a léčba. str. 109–110.

14. Kooby, D. A., et al. Influence of Transfusions on Perioperative and Long-Term Outcome in Patients Following Hepatic Resection for Colorectal Metastases. Ann. Surg., Vol. 237, No. 6, 860–870.

15. Stephenson, K. R., Steinberg, S. M., Hughes, K. S., et al. Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Ann. Surg., 1988; 208: 679–687.

16. Younes, R. N., Rogatko, A., Brennan, M. F. The influence of intraoperative hypotension and perioperative blood transfusion on disease-free survival in patients with complete resection of colorectal liver metastases. Ann. Surg., 1991; 214: 107–113.

17. Rosen, C. B., Nagorney, D. M., Taswell, H. F., et al. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann. Surg., 1992; 216: 493–504.

18. Yamamoto, J., Kosuge, T., Takayama, T., et al. Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery, 1994; 115: 303–309.

19. Lesurtel, M., et al. How Should Transection of the Liver Be Performed? A Prospective Randomized Study in 100 Consecutive Patients: Comparing Four Different Transection Strategies. Ann. Surg., 2005; 242(6): 814–822.

20. Belghiti, J., Noun, R., Malafosse, R., et al. Continuous versus intermittent portal triad clamping for liver resection. A controlled study. Ann. Surg., 1999; 229: 369–375.

21. Clavien, P. A., Selzner, M., Rudiger, H. A., et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning. Ann. Surg., 2003; 238: 843–850; discussion 851–852.

22. Clavien, P. A., Yadav, S., Sindram, D., et al. Protective effects of ischemic preconditioning for liver resection performed under inflow occlusion in humans. Ann. Surg., 2000; 232: 155–162.