Usefulness and application of the liver hanging maneuver for anatomical liver resections

Abstract

Background: To achieve complete anatomic hepatectomy, hepatic transection by an anterior approach is useful. The liver hanging maneuver is a useful procedure for transection of adequate cut plane in anatomical liver resections and may reduce intraoperative bleeding and transection time.

Methods: We examined the records of 71 patients who underwent anatomic hepatic resection with (n = 24, between 2001 and September 2007) or without liver hanging maneuver (LHM) (n = 47, between 2000 and 2003). Groups were historically compared in terms of patient demographics, preoperative hepatic function, surgical records, and outcome. LHM was conducted according to the Belghiti's original method.

Results: LHM could be performed not only in hemihepatectomy but also in right and left trisectionectomy. Demographics and preoperative hepatic function tests were not significantly different between the LHM and non-LHM groups. Although intraoperative bleeding, blood transfusion, and operating time were not significantly different between groups, the time required for liver parenchymal transection was significantly shorter in the LHM group (36.5 +/- 9.9 vs. 48.1 +/- 12.7 min, P = 0.004). Postoperative liver function, morbidity, and mortality were not significantly different between the groups. In other hepatectomy with cut plane along the right hepatic vein, the transection time tended to be shorter in the LHM group (n = 5, 32.4 +/- 6.1 min) than in the non-LHM group (n = 5, 44.4 +/- 8.3 min), albeit insignificantly (P = 0.06).

Conclusion: LHM can reduce the transection time at the cut plane in hepatic resections. Our results emphasized the advantages and usefulness of LHM in anatomical liver resections.