The effect of Pringle maneuver in surgical outcome in patients underwent extended hepatectomy

Background:

Intraoperative bleeding and postoperative complications remains challenging following extended hepatectomy (EH). Despite the ongoing decades-long controversy regarding the advantages and disadvantages of bleeding control during hepatectomy, the Pringle maneuver (PM) remains the most commonly used type of clamping. However, the role and use of PM during EH are still controversial. The aim of this study is to evaluate the effect of PM on the outcome in patients underwent EH.

Methods:

A series of 209 consecutive patients underwent EH (resection of ≥ five liver segments) between 2001 and 2017. Fifty of them (23.9%) underwent PM during EH with a mean duration of 9.4 ± 4.0 minutes. The association of PM with intraoperative bleeding, posthepatectomy haemorrhage (PHH), and major morbidity (based on Clavien-Dindo classification) was evaluated using multivariate regression analysis.

Results:

There were no significantly differences regarding preoperative and intraoperative data such as demographic data, transection technique, and site of resection. However, the rate of metastatic disease and preoperative chemotherapy were significantly higher in patients with PM (p = 0.001). Multivariate analysis revealed that risk of intraoperative bleeding ≥1500 ml (odds ratio [OR] 3.7, 95% confidence interval [CI] 1.5 – 8.9, p = 0.003), PHH (OR 4.3, 95% CI 1.3 – 15.1, p = 0.021), and major morbidity (OR 2.4, 95% CI 1.0 – 5.6, p = 0.040) were significantly lower in patients underwent PM after EH.

Conclusions:

PM is associated with lower intraoperative bleeding (≥1500 ml), PHH, and major morbidity risk following EH. This association was independent of other related parameters. Further prospective studies are needed to evaluate the role of PM on perioperative outcomes after EH.