One hundred consecutive hepatic resections. XXXX , transfusion, and operative technique.

@entity190 @entity1
BACKGROUND: Hepatic resection is prone to significant @entity190 . Adverse effects of @entity190 and transfusion mandate improvements in surgical techniques to reduce @entity190 and transfusion requirements. METHODS: One hundred hepatic resections were carried out using a standard surgical technique that includes control of the hilar structures, extrahepatic control of the hepatic veins, and use of the Pringle maneuver. Low central venous pressure and Trendelenburg positioning were used during parenchymal transection. Data were collected retrospectively in the first 36 @entity1 , whereas data were collected prospectively in the remaining 64 @entity1 . RESULTS: Hospital mortality was 3%. Median @entity190 was 450, 700, 1000, 1100, and 1500 mL for segmental, nonanatomic, lobar, extended right, and extended left resections, respectively. Major resections were more likely than minor resections to be transfused with albumin (P = .008), fresh frozen plasma (P = .009), and packed red blood cells or whole blood (P = .04). Overall transfusion of packed red blood cells or whole blood occurred in 59 of 100 @entity1 . In the 64 @entity1 who were followed up prospectively, the predeposit of autologous blood decreased the need for homologous transfusions from 56% to 38%. A further reduction in the transfusion rate of 25% could have been possible if all @entity1 in the prospective group had donated 2 U of autologous blood. @entity1 who predeposited blood were more likely to receive transfusions and to have had a transfusion more than 24 hours after surgery than were @entity1 who did not donate blood. CONCLUSIONS: The surgical techniques used results in acceptable @entity190 and transfusion requirements for hepatic resection. This approach is safe, cost-effective, reproducible, and applicable for widespread use.
