The continuous Pringle maneuver allows for shorter total occlusio

The continuous Pringle maneuver allows for shorter total occlusion time, and has the advantage of avoiding interruption of the parenchymal transaction (20). Belghiti and colleagues nevertheless demonstrated that this does not necessarily translate into shorter overall operative time (21). Both the continuous and intermittent methods Inhibitors,research,lifescience,medical should be used for shorter time periods in the setting of chronically diseased livers or patients that have undergone preoperative chemotherapy. In the setting of chronic liver disease, the intermittent method has been shown to be better tolerated (22). Total hepatic vascular Crizotinib research buy exclusion is another method of reducing

blood loss during liver resection by occluding the inflow and outflow. This technique mitigates the risk of retrograde hepatic Inhibitors,research,lifescience,medical vein bleeding and can decrease the risk of air embolism. Hepatic vascular exclusion is more technically difficult than pedicle clamping alone, as it requires complete mobilization of the liver and appropriate exposure of

the inferior vena cava. This method may be performed by clamping the portal triad in addition to clamping the infrahepatic and suprahepatic vena cava, or more selectively by clamping the hepatic veins extraparenchymally and preserving caval flow. One of the major challenges of total hepatic Inhibitors,research,lifescience,medical vascular occlusion is the hemodynamic effects it induces, which may be poorly tolerated in up to 15% of patients (14). There is a 40-60% decrease in cardiac output and blood pressure, with the resulting compensatory mechanisms of tachycardia and increased systemic vascular resistance (23). It is associated with an increased risk of postoperative Inhibitors,research,lifescience,medical complications, increased operative time,

Inhibitors,research,lifescience,medical and lacks significant benefit over portal triad clamping alone with regards to blood loss, transfusion requirements, and liver failure (14,24,25). Another technique important in decreasing blood loss and operative time involves intrahepatic pedicle ligation. Ligation of the right, left or smaller branches of the portal vasculature supplying the portion of liver being resected is an important step in liver resection. The previous mentioned techniques of vascular control are important for controlling back bleeding from the adjacent segments of liver during transection. these Understanding the anatomy of the portal vessels permits a safe approach to pedicle ligation. Portal triad consists of common hepatic duct, portal vein and hepatic artery (Figure 1). The triad is encased by Glisson’s capsule. As the portal triad enters the hilum of the liver, it splits into the right and left portal pedicles. The right further splits into the anterior and posterior branches. The left travels in the umbilical fissure and gives branches to segments II, III, IV.

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