Introduction: Regardless of the type of surgical intervention to remove LH, massive blood loss remains the “Achilles heel”. Therefore, the preventive imposition of a tourniquet on the hepatoduodenal ligament (PM) should be performed in all patients without exception, but without tightening.
Objective: To study the effect of Pringle maneuver on blood loss in surgical treatment of LH.
Materials and methods: For the period 2006 - 2018, 101 patients with LH were operated on in the MMA surgery clinics, and 111 tumors were removed. 84 resections and 27 enucleations were performed, and in 36% (n = 35) of the cohort PM was used. The advantages and disadvantages of PM, its influence on blood loss and ischemic reperfusion trauma are analyzed.
Results: In the study group we studied, blood loss ranged from 20 to 400 ml, with an average value of 173.5 ml. When using PM, the average blood loss is 223.7 ml. In other operations, the average blood loss was 146.8 ml. In operations using PM, blood loss was greater by an average of 76.82 ml (p <0.000). Of the 59 anatomical resections performed, 14 (23.7%) underwent PM. Blood loss with the use of PM in anatomical resections (with direct parenchymal transection) was on average 126.4 ml higher than in anatomical resections (controlled hepatectomy) without the use of PM (p <0.000). 45 anatomical resections without PM and 21 atypical resections and enucleations with PM were performed. Blood loss in atypical resections and enucleations with PM was on average 42.1 ml higher than in anatomical resections without PM, the difference being statistically significant (p = 0.045).
Discussion: With the use of modern technologies and thanks to advanced techniques for the anatomical separation of gleason and caval structures, when performing large-scale anatomical resections, a significant reduction in intraoperative blood loss is achieved without using the Pringle method. At the same time, in patients who have received the Pringle method in combination with non-anatomical resections or enucleations, blood loss reaches 800 ml and more. There is no bleeding during the parenchymal transection, but after declamation the bleeding reaches 300 ml and more.
Conclusion: Prolonged anatomical parenchymal transection results in significantly less intraoperative bleeding and shortens the time for final hemostasis.
Pringle maneuver (PM), SHVO, blood loss, hepatic hemangioma, anatomical resection, atypical resection, enucleation