Inflow control may safely reduce blood loss in laparoscopic subsegmentectomy of liver
A recent study scrutinized various inflow control methods used during laparoscopic subsegmentectomy in liver resections to determine their impact on patient outcomes. This study was published in BMC Surgery by Wang and colleagues. The study offers clinicians substantial evidence that both the half-Pringle and Pringle maneuvers are safe and effective methods for inflow control during laparoscopic liver resections. Conducted between October 2010 and December 2020, the study evaluated 133 patients who underwent laparoscopic subsegmentectomy under the care of a single surgeon at a specific institute. The study aimed to compare perioperative and long-term outcomes associated with three different inflow control techniques.
The 133 patients were categorized into three groups based on the inflow control method used: no inflow control (49 patients), half-Pringle maneuver (46 patients), and Pringle maneuver (38 patients). Analysis revealed differences among the groups, notably a lower proportion of patients with cirrhosis in the half-Pringle maneuver group, fewer previous abdominal or liver surgeries in the same group, and more anterolateral segment tumors in the no inflow control group.
- Cirrhosis Rates: Half-Pringle group: Lower proportion (P = .02).
- Previous Surgeries: Fewer abdominal and liver surgeries in the half-Pringle group (P = .01 and P = .02 respectively).
- Tumor Location: More tumors in anterolateral segments in the no inflow control group (P = .001).
- Operative Outcomes: Shorter operation time in the no inflow control group (P < .001). Less blood loss observed in the no inflow control group (P = .03).
- Postoperative Measures: No significant differences in the need for blood transfusion, morbidity, or hospital stay among the three groups.
- Long-Term Survival: Overall survival did not significantly differ among the groups (P = .89).
The study reported that the operation time was shorter and blood loss was less in the no inflow control group compared to the other groups. However, there were no significant differences among the groups regarding the need for blood transfusion, postoperative complications, or length of hospital stay. Additionally, the overall survival rates did not differ significantly among the three groups. The findings suggest that both the half-Pringle and Pringle maneuvers showed comparable perioperative and long-term outcomes in laparoscopic subsegmentectomy.
Reference:
Wang, H.-P., Hou, T.-Y., Li, W.-F., & Yong, C.-C. Inflow control can be safely used in laparoscopic subsegmentectomy of the liver: a single-center 10-year experience. BMC Surgery,2023;23(1). https://doi.org/10.1186/s12893-023-02282-2
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