The Effects of Intermittent Hepatic Inflow Occlusion Using the Pringle Maneuver During Hepatectomy

The Pringle maneuver is currently used in most institutions to prevent intraoperative hemorrhage during hepatectomy by occluding the blood flow to the liver. We investigated the postoperative effects of hepatic inflow occlusion time during hepatectomy. The surgical outcomes of 831 patients who underwent hepatic resection for liver tumors were retrospectively reviewed, including the association of hepatic inflow occlusion time with surgical outcomes and remnant liver regeneration. The Student's t and chi(2) tests, Mann-Whitney's U test, Wilcoxon's signed-rank test, or Fisher's exact test were used. Patients were divided into two groups: the normal liver group (fibrosis stage 0-1; n = 560) and diseased liver group (fibrosis stage 2-4; n = 271). The Pringle maneuver was performed in 522 (62.8%) patients. The median occlusion time was 45 (9-167) min. There was an association between extended ischemia time and unfavorable blood test results in the early postoperative period. However, regardless of the ischemia time, the patients recovered by the 14(th) postoperative day. There were no correlations between total ischemia time and the frequency of postoperative complications in either the normal or diseased liver groups (p = 0.262 and 0.099, respectively). There were no correlations between ischemia time and remnant liver regeneration at 7 days, and 1, 2, 5, and 12 months, postoperatively, in either the normal or diseased liver groups. The intermittent Pringles maneuver over shorter periods was associated with favorable postoperative outcomes and complications, and had no significant effect on remnant liver regeneration.