@article{3142786,
    title = "The introduction of a simple maneuver to reduce the risk of
postoperative bleeding after major hepatectomies",
    author = "Vassiliou, Ioannis and Arkadopoulos, Nikolaos and Stafyla, Vaia and and Theodoraki, Kassiani and Yiallourou, Anneza and Theodosopoulos, and Theodosios and Kotis, George and Fragoulidis, George and Kotsis, Thomas and and Smyrniotis, Vassilios",
    journal = "Journal of Hepato-Biliary-Pancreatic Surgery",
    year = "2009",
    volume = "16",
    number = "4",
    pages = "552-556",
    publisher = "SPRINGER JAPAN KK",
    issn = "0944-1166, 1436-0691",
    doi = "10.1007/s00534-009-0100-z",
    keywords = "Central venous pressure; Pringle maneuver; Hepatic veins; Inferior vena
cava; Liver ischemia",
    abstract = "In major hepatectomies, postoperative increases in central venous
pressure (CVP) may cause suture failure and massive bleeding. The aim of
our study is to test the application of an intraoperative maneuver to
reduce the risk of postoperative bleeding.
Our study included 172 consecutive patients who had major liver
resection with selective hepatic vascular exclusion and sharp
transection of the liver parenchyma. An intraoperative maneuver (5 s
occlusion of the hepatic vein) was applied in an alternating way, and
the patients were assigned to two groups: Cohort A (n = 86), that was
granted the maneuver, and Cohort B (n = 86), that was used as a control
group.
In Cohort A, application of the maneuver was successful in demonstrating
bleeders under low CVP levels. Cohort A had lower rate of massive
bleeding requiring emergency reoperation (2.3 vs 5.8%, P = 0.049), less
postoperative blood transfusions (13 vs 24%, P = 0.042), lower
morbidity (20 vs 35%, P < 0.045) and shorter hospital stay compared to
Cohort B.
Hepatectomies conducted under low CVP are prone to postoperative
hemorrhage which can be prevented if the final bleeding control is
performed under high pressure in the hepatic veins. Application of our
testing maneuver effectively unmasked previously undetectable bleeding
veins."
}