The effect of portal triad clamping on outcome after hepatic resection is uncertain.
Dr Rahbari and colleagues assessed the effectiveness, and safety of portal triad clamping alone, and of portal triad clamping with ischemic preconditioning of the liver.
|Postoperative alanine aminotransferase levels were lower with ischemic preconditioning|
|The British Journal of Surgery|
The research team conducted a systematic literature search to detect randomized controlled trials.
The team then performed a meta-analyses using a random-effects model.
Studies on clamping of the inferior vena cava or hepatic veins were excluded.
The team identified 8 randomized controlled trials published between 1997 and 2006 containing a total of 558 patients eligible for final analysis.
Endpoints included postoperative overall morbidity, and mortality, cardiopulmonary, and hepatic morbidity, blood loss, transfusion rates, and alanine aminotransferase levels.
Analyses of endpoints revealed no difference between intermittent portal triad clamping, and no portal triad clamping.
Portal triad clamping with, and without previous ischaemic preconditioning revealed no differences.
However, the team observed that postoperative alanine aminotransferase levels were significantly lower with ischemic preconditioning.
Dr Rahbaris' team concluded, "On currently available evidence, the routine use of portal triad clamping does not offer any benefit in perioperative outcome after liver resection."
"It cannot be recommended as a standard procedure."