Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure

Kazuhisa Uchiyama, Masaki Ueno, Satoru Ozawa, Shinya Hayami, Manabu Kawai, Masaji Tani, Kazuhiro Mizumoto, Masanori Haba, Yoshio Hatano, Hiroki Yamaue
Langenbeck's Archives of Surgery 2009, 394 (2): 243-7

BACKGROUND AND AIMS: Bleeding from the hepatic vein is closely related to central venous pressure (CVP). To evaluate the effect of low central venous pressure during a hepatectomy, the infrahepatic inferior vena cava (IVC) was half clamped.

PATIENTS AND METHODS: Between 2006 and 2007, 20 patients undergoing major hepatectomy with the IVC half clamping (half-clamping group) were compared with 58 patients undergoing hepatectomy without IVC half clamping between 2003 and 2005 (control group). The types of liver resection, amount of blood loss during the hepatectomy, volume of blood transfusion, length of hospital stay, and complications were compared between the two groups.

RESULTS: In the half-clamping group, blood loss was decreased in comparison to the control group (p = 0.041) and the suprahepatic CVP was low (2.4 +/- 1.8 mmHg; p = 0.0002). The diameter at the root of the right hepatic vein was reduced in comparison to before clamping (5.8 +/- 1.6 mm; p < 0.001). There were no complications of half clamping on any hemodynamic and blood electrolytic parameters.

CONCLUSION: Using the half clamping technique of the IVC, intra-operative CVP was maintained below 3 mmHg without any side effects, and the low CVP significantly reduced the bleeding from hepatic veins during a major hepatectomy.

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