The renal sequelae of a novel triphasic approach to blood loss reduction during hepatic resection

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
S J MougP G Horgan

Abstract

To report our novel triphasic approach to minimising blood loss during hepatic resection and the renal sequelae. Fifty consecutive patients (median age 63.3 years, range 37-86) underwent hepatic resection. Triphasic approach consisted of: pre-operative bowel preparation with no supplementary fluids; intraoperative intravenous fluid restriction with low central venous pressure (<5 cmH2O) and continuous selective occlusion of the left or right portal structures and corresponding hepatic vein/s. The following variables were analysed: blood loss; transfusion requirements; perioperative renal function; perioperative morbidity and mortality. Median estimated blood loss was 330 mL (range 50-1200). No patient was transfused intraoperatively, with two patients transfused post-operatively. Median intraoperative urine output prior to hepatic re-perfusion was 28.4 mL/h (range 13.3-40.0) with no patient developing renal impairment. Morbidity occurred in 22% of patients with no documented hepatic failure. There was zero 30-day mortality. Pre-operative dehydration and intraoperative fluid restriction combined with continuous selective vascular occlusion minimizes blood loss during hepatic resection with no consequent detriment to renal function.

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Citations

Sep 3, 2013·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Joey SiuSaxon Connor
Dec 26, 2009·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·S J MougP G Horgan
May 23, 2007·Surgical Oncology·Susan J Moug, Paul G Horgan
Mar 21, 2007·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·S J MougP G Horgan
Jan 30, 2008·Anesthesia and Analgesia·Syed Z AliStephan M Jakob

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