Usefulness of Intraoperative Measurement of Portal Venous Pressure for Confirming the Most Appropriate Hepatectomy in Patients with Borderline Hepatic Functional Reserve

Abstract

Background We investigated whether portal venous pressure (PVP) measured immediately before surgery and then immediately after clamping of the Glissonian pedicle can be used to predict postoperative complications (ascites or jaundice) and thus select the extent of resection in patients with liver disease requiring hepatectomy.
Methods Thirty-seven patients with hepatic functional reserve near the advisable limit and in whom direct measurement of PVP was done just before surgery and after clamping of the Glissonian pedicle were divided into two groups, an Event group (n = 9) and a Non-event group (n = 28), according to whether postoperative complications developed. The relation between PVP and the complication rate was analyzed, and a PVP safety margin was identified.
Results PVP obtained after the Glissonian pedicle was clamped was significantly higher in the Event group than in the Non-event group (18.8 vs. 15.7 cmH₂O; p = 0.03). The PVP gradient (defined as PVP after Glissonian clamping – PVP before surgery) tended to be greater in the Event group (5.1 versus 3.6 cmH₂O; p = 0.13). PVP after Glissonian clamping plotted against the PVP gradient revealed safety margins of PVP gradient < 5 cmH₂O and PVP < 20 cmH₂O, respectively.
Conclusion PVP after Glissonian clamping and the PVP gradient may be useful for predicting post-hepatectomy complications.