Abstract
Background: Intermittent occlusion of hepatic inflow, so-called Pringle’s maneuver, is a useful technique to control intraoperative
bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors,
posthepatectomy liver function and morbidity.
Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013
were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated with
hepatic-inflow occlusion time were performed.
Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively.
The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time,
amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p ‹ 0.05). Blood loss upon the use of
occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter
in limited resection and longer in central bi-segmentectomy or sectionectomy (p ‹ 0.05). The occlusion time was significantly correlated
with the maximum alanine aminotransferase level (r=0.291, p ‹ 0.01). The predictive cut-off value of occlusion time for
these correlated parameters ranged between 45 and 46.5 minutes (p ‹ 0.05). Hepatic-inflow occlusion was not associated with
morbidity in cirrhosis.
Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury,
complication rate and duration of hospital stay.
