In Situ and Surface Liver Cooling With Prolonged Inflow Occlusion During Hepatectomy in Patients With Chronic Liver Disease

Objective: We examined in situ and surface liver hypothermia with continuous and prolonged inflow occlusion during hepatic resection (segmentectomy or subsegmentectomy). Participants: Eight patients with cirrhosis and three with chronic hepatitis. Method: In situ chilling was achieved by introducing cold Ringer's lactate solutoin through the portal vein, under conditions of portal triad occlusion. Results: The liver tissue temperature fell to a mean of 28.4°C 5 minutes later. The time of ischemia ranged from 32 to 52 minutes (mean±SD, 47.8±5.6 minutes). The mean blood loss was significantly lower than in our conventional hepatectomy series (680 vs 1520 mL, P Main Outcome: There were no serious complications, and hypoxia-induced liver injury was ameliorated, as shown by liver function tests. Conclusion: Hepatectomy with prolonged inflow occlusion is justified in low-risk patients with chronic liver disease if it is combined with liver hypothermia, such as simple in situ and surface cooling. (Arch Surg. 1994;129:620-624)