Selective Hepatic Vascular Exclusion Versus Pringle Maneuver in Major Hepatectomy: A Systematic Review and Meta-Analysis

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Apr 25

PMID 35465416

Authors

Shahd Mobarak

Martyn C Stott

Munir Tarazi

Rebecca J Varley

Madhav S Dave

Minas Baltatzis

Thomas Satyadas

Affiliations

Soon will be listed here.

Abstract

Objectives: Mortality and morbidity following hepatic resection is significantly affected by major intra-operative blood loss. This systematic review and meta-analysis evaluates whether selective hepatic vascular exclusion (SHVE) compared to a Pringle maneuver in hepatic resection reduces rates of morbidity and mortality.

Methods: A systematic review and meta-analysis were conducted according to the PRISMA guidelines by screening EMBASE, MEDLINE/PubMed, CENTRAL and SCOPUS for comparative studies meeting the inclusion criteria. Pooled odds ratios or mean differences were calculated for outcomes using either fixed- or random-effects models.

Results: Six studies were identified: three randomised controlled trials and three observational studies reporting a total of 2,238 patients. Data synthesis showed significantly decreased rates of mortality, overall complications, blood loss, transfusion requirements, air embolism, liver failure and multi-organ failure in the SHVE group. Rates of hepatic vein rupture, post-operative hemorrhage, operative and warm ischemia time, length of stay in hospital and intensive care unit were not statistically significant between the two groups.

Conclusion: Performing SHVE in major hepatectomy may result in reduced rates of morbidity and mortality when compared to a Pringle maneuver. The results of this meta-analysis are based on studies where tumors were adjacent to major vessels. Further RCTs are required to validate these results.

Clinical Trial Registration: PROSPERO (CRD42020212372) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=212372.

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