Outcomes after liver resection with and without intermittent portal triad clamping (Pringle’s manoeuver)

Abdul Rehman, Naganath Babu Obla .



Aim: The purpose of this study was to assess the influence of  intermittent portal triad clamping versus no clamping on the outcomes of liver resection.

 Materials and Method:From July 2014 to March 2017,        30 patients who underwent liver resection with intermittent portal clamping were matched to 30 patients who underwent liver resection without  portal clamping during the same time using propensity score matching. The selective use of portal triad clamping and   technique of parenchymal transection during the liver         resection was at the discretion of the operating surgeon. LowCVP (central venous pressure)     anesthesia and restricted volume replacement during        parenchymal transections were performed to minimize    bleeding in all cases of liver resection. Parameters analysed included demographic profile, duration of surgery, amount of blood loss, transfusion, liver function tests (LFT’s) in the     post operative period. Morbidity & mortality were analyzed by Independent t test, Chi-square test,  Fisher's exact test.

Results:There was no significant difference in preoperative laboratory data , age and sex, condition of liver &disease condition, type of hepatectomy in both the groups after    propensity score matching.

Overall there is no significant difference in operating time& blood loss but parenchymal transection times were increased in the portal triad clamping group (p=0.003).LFT’s were significantly raised in the portal triad clamping group on Day1. Liver failure (Grade A and B) and wound infection were  significantly noted in patients with portal triad clamping. Mortality cause correlation showed significant increase in liver failure causing death in   patients who had portal triad clamping (p=0.027).Conclusion:Liver resections can be performed safely without portal triad clamping with the advances in liver   anesthesia, improved surgical technique and advanced hemostatic technologies. Portal triad clamping is associated with increased post hepatectomy liver failure (Grade A and B) and should be employed selectively.



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