Application of selective hepatic inflow occlusion in laparoscopic hepatectomy

Objective To investigate the safety and efficacy of selective hepatic inflow occlusion in laparoscopic hepatectomy.

Methods A retrospective analysis was conducted on the clinical data of 64 patients who underwent laparoscopic hepatectomy. Based on the different methods of hepatic inflow occlusion, the patients were divided into Pringle occlusion group with 31 patients (using intermittent Pringle's maneuver) and selective occlusion group with 33 patients (using selective hepatic inflow occlusion). The general, intraoperative, and postoperative data were compared between the two groups.

Results There were no statistically significant differences in general data, operative time, intraoperative blood loss, central venous pressure, and mean arterial pressure between the two groups (P>0.05). On postoperative day 3, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil) in the selective occlusion group were lower than those in the Pringle occlusion group (P < 0.05). There were no statistically significant differences in length of hospital stay and postoperative complication rates between the two groups (P>0.05). Subgroup analysis showed that in patients undergoing laparoscopic hemihepatectomy, the AST and ALT levels on postoperative day 3 were lower in the selective occlusion group than in the Pringle occlusion group (P < 0.05). In patients undergoing laparoscopic liver segmentectomy, the TBil level on postoperative day 3 was lower in the selective occlusion group than in the Pringle occlusion group (P < 0.05), but there were no statistically significant differences in AST and ALT levels between the two groups (P>0.05).

Conclusion Selective hepatic inflow occlusion demonstrates good safety and efficacy in laparoscopic hepatectomy. It can significantly reduce postoperative liver function damage, especially in patients undergoing hemihepatectomy.