%0 Journal Article
%T Bleeding in Hepatic Surgery: Sorting through Methods to Prevent It
%A Fabrizio Romano
%A Mattia Garancini
%A Fabio Uggeri
%A Luca Degrate
%A Luca Nespoli
%A Luca Gianotti
%A Angelo Nespoli
%A Franco Uggeri
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/169351
%X Liver resections are demanding operations which can have life threatening complications although they are performed by experienced liver surgeons. The parameter Ħ°Blood LossĦħ has a central role in liver surgery, and different strategies to minimize it are a key to improve results. Moreover, recently, new technologies are applied in the field of liver surgery, having one goal: safer and easier liver operations. The aim of this paper is to review the different principal solutions to the problem of blood loss in hepatic surgery, focusing on technical aspects of new devices. 1. Introduction Liver resection is considered the treatment of choice for liver tumours. Despite standardized techniques and technological advancing for liver resections, an intraoperative haemorrhage rate ranging from 700 to 1200£żmL is reported with a postoperative morbidity rate ranging from 23% to 46% and a surgical death rate ranging from 4% to 5% [1¨C6]. The parameter Ħ°Blood lossĦħ has a central role in liver surgery and different strategies to minimize it are a key to improve these results. Bleeding has to be considered a major concern for the hepatic surgeon because of several reasons. At first, it is certainly the major intraoperative surgical complication and cause of death and historically one of the major postoperative complication together with bile leaks and hepatic failure [5¨C9]. Besides, a high intraoperative blood loss is associated with a higher rate of postoperative complication and shorter long-term survival [10¨C13]. Furthermore, it is associated with an extensive use of vessel occlusion techniques, directly correlated with higher risk of postoperative hepatic failure. Last, a higher value of intraoperative blood loss is associated with a higher rate of perioperative transfusions; and host immunosuppression associated with transfusions with a dose-related relationship is correlated with a higher rate of complication (in particular infections) and recurrence of malignancies in neoplastic patients [11, 12, 14¨C21]. In order to reduce transfusions, hepatic surgeon has also not to misinterpret postoperative fluctuations of blood parameter: Torzilli et al. demonstrated that haemoglobin rate and haematocrit after liver resection show a steady and significant decrease until the third postoperative day and then an increase, so this situation has to be explained as physiological and does not justifies blood administration [22]. 2. How Can We Reduce Bleeding in Liver Surgery? This study is based on the literature information and our own experience. The aim of the study is to
%U http://www.hindawi.com/journals/hpb/2012/169351/