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Central hepatectomy under sequential hemihepatic control

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Abstract

Purpose

Central hepatectomy is a complex, parenchymal-sparing procedure which has been associated with increased blood loss, prolonged operating time, and increased duration of remnant hypoxia. In this report, we compare two different techniques of vascular control, namely sequential hemihepatic vascular control (SHHVC) and selective hepatic vascular exclusion (SHVE) in central hepatectomies.

Methods

From January 2000 to September 2011, 36 consecutive patients underwent a central hepatectomy. SVHE was applied in 16 consecutive patients, and SHHVC was applied in 20 patients. Both groups were comparable regarding their demographics.

Results

Total operative time and morbidity rates were similar in both groups. Warm ischemia time was significantly longer in SVHE patients (46 min vs 28 min, p = 0.03). Total blood loss and number of transfusions per patient were also higher in the SVHE group (650 vs. 400 mL, p = 0.04 and 2.2 vs. 1.2 units, p = 0.04, respectively). AST values were significantly higher in SVHE on days 1 and 3 compared to SHHVC patients (650 vs. 400, p = 0.04 and 550 vs. 250, p = 0.001, respectively).

Conclusion

Sequential hemihepatic vascular control is a safe technique for central hepatectomies. Decreased intraoperative blood loss and transfusions and attenuated liver injury are the main advantages of this approach.

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Conflicts of interest

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Authors and Affiliations

  1. 4th Department of Surgery, Athens University School of Medicine, Attikon University Hospital, 17 Efpatorias str., 11522, Athens, Greece

    Nikolaos Arkadopoulos, Maria A. Kyriazi, Pantelis Vassiliou, Apostolos Perelas & Vassilios Smyrniotis

  2. 1st Department of Anesthesiology, Athens University School of Medicine, Areteion University Hospital, Athens, Greece

    Kassiani Theodoraki

  3. 2nd Department of Surgery, Athens University School of Medicine, Areteion University Hospital, Athens, Greece

    Ioannis Vassiliou

Authors
  1. Nikolaos Arkadopoulos
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  2. Maria A. Kyriazi
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  3. Kassiani Theodoraki
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  4. Pantelis Vassiliou
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  5. Apostolos Perelas
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  6. Ioannis Vassiliou
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  7. Vassilios Smyrniotis
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Corresponding author

Correspondence to Maria A. Kyriazi.

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Author's contributions

NA helped with the study conception and design and drafting the manuscript; MK, with the acquisition, analysis, and interpretation of data and drafting of the manuscript; KT, with the analysis and interpretation of data; PV, with the acquisition, analysis, and interpretation of data; AP, with the acquisition of data; IV, with the critical revision of the manuscript; and VS, with the study conception and design and critical revision of the manuscript.

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Arkadopoulos, N., Kyriazi, M.A., Theodoraki, K. et al. Central hepatectomy under sequential hemihepatic control. Langenbecks Arch Surg 397, 1283–1288 (2012). https://doi.org/10.1007/s00423-012-0984-y

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  • DOI: https://doi.org/10.1007/s00423-012-0984-y

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