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Invited Critique
April 2008

Use of Vascular Clamping in Hepatic Surgery: Lessons Learned From 1260 Liver Resections—Invited Critique

Arch Surg. 2008;143(4):388. doi:10.1001/archsurg.143.4.388

One of the major concerns associated with liver resections continues to be minimization of blood loss. In this article, Ercolani et al have demonstrated that the volume of blood transfusion (an indirect value for blood loss) is a statistically significant risk factor for increased morbidity and mortality following hepatic resection. As in other studies,1,2 the authors have identified the number of segments resected and the presence of cirrhosis as other risk factors for increased morbidity. Vascular control during hepatectomy remains a debated subject. Proponents state that total vascular exclusion and continuous inflow occlusion lead to decreased blood loss. Opponents argue that selective or no clamping is accompanied by decreased ischemia-reperfusion injury. The few randomized trials have not clearly shown that any method is superior.3-5

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