eISSN: 1897-4317
ISSN: 1895-5770
Gastroenterology Review/Przegląd Gastroenterologiczny
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SCImago Journal & Country Rank
2/2022
vol. 17
 
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Artykuł oryginalny

Does repeat laparoscopic hepatectomy without extracorporeal Pringle manoeuvre worsen treatment outcomes?

Yoshihiro Inoue
1
,
Yusuke Suzuki
2
,
Masato Ota
2
,
Kazuya Kitada
2
,
Toru Kuramoto
1
,
Kentaro Matsuo
1
,
Kensuke Fujii
1
,
Yuta Miyaoka
1
,
Fumiharu Kimura
1
,
Kazuhisa Uchiyama
1

1.
Osaka Medical College Mishima-Minami Hospital, Osaka, Japan
2.
Osaka Medical College Hospital, Osaka, Japan
Gastroenterology Rev 2022; 17 (2): 130–137
Data publikacji online: 2021/10/13
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Introduction
The Pringle manoeuvre is used in most hospitals to counteract intraoperative haemorrhage in laparoscopic hepatectomy by occluding the flow of blood to the liver. However, in laparoscopic repeat hepatectomy (LRH), outcomes of previous surgery and the influence of other factors frequently make it difficult to occlude the inflow of blood.
Aim: To discuss the value of inflow occlusion during LRH and provide tips for its performance.

Material and methods
Sixty-three patients who underwent LRH with or without the Pringle manoeuvre were analysed retrospectively. We investigated the efficacy and safety of the Pringle manoeuvre in LRH. Student’s t and 2 tests, Mann-Whitney’s U test, Wilcoxon’s signed-rank test, and Fisher’s exact test were used in the statistical analysis.

Results
Nineteen patients underwent LRH with the Pringle manoeuvre, and 44 patients underwent LHR without the Pringle manoeuvre. After propensity score matching, there were no significant differences in terms of operative time, estimated blood loss, and postoperative complication rate (p = 0.973, 0.120, and not applicable, respectively). However, the rate of conversion to open repeat hepatectomy (ORH) was significantly lower in the Pringle manoeuvre group (p = 0.034). In many cases, the cause of conversion to ORH was the non-use of inflow occlusion and the resulting inability to control intraoperative haemorrhage. Laboratory data collected after surgery showed no significant difference between the 2 groups regardless of whether blood flow was occluded or not.

Conclusions
LRH with the Pringle manoeuvre can be performed safely using various surgical devices. However, it is often challenging to perform the Pringle manoeuvre in patients with a history of cholecystectomy or segment 5 resection of the liver, and caution is required.

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