Abstracts
2000 Digestive Disease Week

# 2279 Continuous Vascular Occlusion for Hepatectomy in Both Cirrhotic and Non-Cirrhotic Patients; Outcome from a Prospective Study.
Nicholas Demartimes, Adolfo Gavelli, Reza Gamagami, Claude Huguet, Monaco

Hemorrhage is the most important risk factor for operative morbidity and mortality in liver resection. The demonstration of good tolerance of normal liver to warm ischemia for periods of up to 85 minutes is well documented. Fears of hepatic failure especially in cirrhotic patients have served as arguments against its routine use. The present study was undertaken to assess the safety and the influence of warm ischemia by the routine use of porta hepatis clamping or total vascular exclusion clamping in both cirrhotic and non-cirrhotic patients undergoing major liver resections. Between 1984 and 1986, 168 consecutive liver resections were preformed by the same senior surgeon at a single institution. Perioperative mortality rates, serum levels of AST, ALT, bilirubin, prothrombin time, and alkaline phosphatase were assessed. Perioperative transfusion requirement was also recorded. 114 non-cirrhotic patients and 19 cirrhotic patients underwent major liver resection. No intraoperative deaths were observed in either groups. The mortality rates within 30 days were 2.3% within the non-cirrhotic group versus 21% in the cirrhotic group. Mean ischemic time for non-cirrhotic was 43.7 minutes (range 12-85) and for cirrhotic patients was 42.5 (range 22-62). Patients without complications, received fewer transfusions. For the cirrhotic group, the average transfused blood products units were 3.6±6.0 intraoperatively and for the non-cirrhotic group 17±4 or of packed RBC s. Biochemical profiles demonstrate increasing levels of AST, ALT, total bilirubin and conjugated bilirubin and a decrease in prothrombin time and alkaline phosphatase levels within the first 24 hours for all patients. For non-cirrhotic survivors return to preoperative values occurred within 7 days and at a slightly longer period for the cirrhotic patients. Major hepatectomy with use of continuous vascular occlusion is well tolerated in both cirrhotic and non-cirrhotic patients. Before abandoning major resection for cirrhotic patients, future studies should evaluate the role of continuous versus intermittent clamping in warm and normothermic state.