Selective hepatic vascular exclusion versus Pringle maneuver in major liver resections: prospective study.

Selective hepatic vascular exclusion (SHVE) and the Pringle maneuver are two methods used to control bleeding during hepatectomy. They are compared in a prospective randomized study, where 110 patients undergoing major liver resection were randomly allocated to the SHVE group or the Pringle group. Data regarding the intraoperative and postoperative courses of the patients are analyzed. Intraoperative blood loss and transfusion requirements were significantly decreased in the SHVE group, and postoperative liver function was better in that group. Although there was no difference between the two groups regarding the postoperative complications rate, patients offered the Pringle maneuver had a significantly longer hospital stay. The application of SHVE did not prolong the warm ischemia time or the total operating time. It is evident from the present study that SHVE performed by experienced surgeons is as safe as the Pringle maneuver and is well tolerated by the patients. It is much more effective than the Pringle maneuver for controlling intraoperative bleeding, and it is associated with better postoperative liver function and shorter hospital stay.

Transthoracic versus transabdominal surgical approach for echinococcal cysts located over the superoposterior aspect of the right lobe of the liver.

A retrospective study of 80 patients operated on for hydatid cysts located on the superoposterior aspect of the right lobe of the liver (segments VI, VII, VIII) is presented. Right thoracotomy was performed in 30 patients, and 50 patients were operated on through bilateral subcostal incisions. The two approaches were compared in terms of radicality and morbidity. The transabdominal approach produced superior results and fewer postoperative complications, resulting in a shorter hospital stay (11 +/- 5 vs. 18 +/- 8 days). Total cystopericystectomy was feasible in 30% of patients operated on transabdominally and in 6% of those approached transthoracically. The rest of the patients were offered partial pericystectomy, except three in the thoracotomy group who underwent simple drainage of the cavity. We recommend that the transabdominal approach be the first choice for treatment of liver hydatid cysts irrespective of their location and size. We abandoned the transthoracic approach for cysts located on the superoposterior aspect of the right liver lobe in 1996. The transabdominal approach enables the surgeon to treat liver hydatidosis in a more radical, safer manner than does the transthoracic approach.