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01-03-2009 | review article

Portal Triad Clamping Versus Vascular Exclusion for Vascular Control During Hepatic Resection: A Systematic Review and Meta-analysis

Authors: Nuh N. Rahbari, Moritz Koch, Arianeb Mehrabi, Kathrin Weidmann, Edith Motschall, Christoph Kahlert, Markus W. Büchler, Jürgen Weitz

Published in: Journal of Gastrointestinal Surgery | Issue 3/2009

Abstract

Objective

To compare the clinical outcome of patients undergoing liver resection under portal triad clamping (PTC) versus hepatic vascular exclusion (HVE).

Methods

A systematic literature search was performed following the guidelines of the Cochrane collaboration. Randomized controlled trials (RCT) comparing PTC to any technique of HVE were eligible for inclusion. Two authors independently assessed methodological quality of included trials and extracted data on overall morbidity, mortality, cardiopulmonary and hepatic morbidity, intraoperative blood loss, transfusion rates, postoperative transaminase and bilirubin levels, prothrombin time, and hospital stay. Meta-analyses were performed using a random-effects model.

Results

Of the 1,383 identified references, four RCTs were finally included. These trials compared PTC to selective hepatic vascular exclusion (SHVE), total hepatic vascular exclusion (THVE), and a modified technique of HVE (MTHVE), respectively. Meta-analyses revealed no significant difference in morbidity and mortality between PTC and techniques of HVE. Further analyses showed significantly reduced overall morbidity for the PTC compared to the THVE group. There was a significantly lower transfusion rate for HVE compared to PTC.

Conclusion

Hepatic vascular exclusion does not offer any benefit regarding outcome of patients undergoing hepatic resection compared to PTC alone. Further, well-designed RCTs evaluating adequate vascular control in major hepatectomy and in patients with underlying liver disease appear justified.

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Title: Portal Triad Clamping Versus Vascular Exclusion for Vascular Control During Hepatic Resection: A Systematic Review and Meta-analysis
Authors: Nuh N. Rahbari
Moritz Koch
Arianeb Mehrabi
Kathrin Weidmann
Edith Motschall
Christoph Kahlert
Markus W. Büchler
Jürgen Weitz
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0588-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Portal Triad Clamping Versus Vascular Exclusion for Vascular Control During Hepatic Resection: A Systematic Review and Meta-analysis

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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