The introduction of a simple maneuver to reduce th

Authors: Ioannis Vassiliou Nikolaos Arkadopoulos Vaia Stafyla Kassiani Theodoraki Anneza Yiallourou Theodosios Theodosopoulos George Kotis George Fragoulidis Thomas Kotsis Vassilios Smyrniotis

Publish Date: 2009/04/21

Volume: 16, Issue: 4, Pages: 552-556

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Abstract

In major hepatectomies postoperative increases in central venous pressure CVP may cause suture failure and massive bleeding The aim of our study is to test the application of an intraoperative maneuver to reduce the risk of postoperative bleedingOur study included 172 consecutive patients who had major liver resection with selective hepatic vascular exclusion and sharp transection of the liver parenchyma An intraoperative maneuver 5 s occlusion of the hepatic vein was applied in an alternating way and the patients were assigned to two groups Cohort A n = 86 that was granted the maneuver and Cohort B n = 86 that was used as a control groupIn Cohort A application of the maneuver was successful in demonstrating bleeders under low CVP levels Cohort A had lower rate of massive bleeding requiring emergency reoperation 23 vs 58 P = 0049 less postoperative blood transfusions 13 vs 24 P = 0042 lower morbidity 20 vs 35 P  0045 and shorter hospital stay compared to Cohort BHepatectomies conducted under low CVP are prone to postoperative hemorrhage which can be prevented if the final bleeding control is performed under high pressure in the hepatic veins Application of our testing maneuver effectively unmasked previously undetectable bleeding veins

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