Open AccessIntermittent Pringle Maneuver and Hepatic Function: Perioperative Monitoring by Noninvasive ICG‐Clearance
Author(s) -
Tralhão José Guilherme,
Hoti Emir,
Oliveiros Bárbara,
Abrantes Ana M.,
Botelho M. Filomena,
CastroSousa F.
Publication year - 2009
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-009-0204-2
Subject(s) - medicine , indocyanine green , occlusion , liver function , abdominal surgery , perioperative , surgery , hepatectomy , anesthesia , resection
Background Intermittent Pringle maneuver or selective portal clamping often are used to control inflow during parenchymal liver transection. This study was designed to determinate whether these maneuvers are associated with adverse hepatic function. Methods Resection was performed without portal clamping in 17 patients (group 1). Selective continuous portal clamping was performed in 11 patients (group 2) and the remaining 33 patients (group 3) had intermittent nonselective portal clamping (occlusion of the main portal trunk). The centers’ protocol for total portal occlusion is 15‐min occlusion alternated with 5‐min reperfusion in patients with normal liver parenchyma or 10 min alternated with 5 min in patients with abnormal parenchyma. ICG elimination tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate (PDR‐ICG‐%/min) and 15‐min retention rate after administration (ICG‐R15‐%). Results There was no statistically difference between the three studied groups in terms of sequential changes of ICG‐PDR ( p < 0.625) or ICG‐R15 ( p < 0.398). Conclusions Our study indicates that 15 min of intermittent Pringle maneuver or selective hemihepatic continuous portal clamping are safe methods of vascular control during liver resection, with no adverse effects on hepatocellular function.