# Perioperative outcomes of utilizing infrahepatic inferior vena cava clamping and Pringle maneuver during hepatectomy: a meta-analysis

## TL;DR

Combining infrahepatic IVC clamping with the Pringle maneuver during liver surgery reduces bleeding and transfusions without increasing complications or surgery time.

## Contribution

This meta-analysis provides evidence that combining IIVCC with PM improves outcomes compared to PM alone during hepatectomy.

## Key findings

- IIVCC+PM significantly reduces intraoperative blood loss and transfusion needs.
- Patients had shorter hospital stays and lower complication rates with IIVCC+PM.
- Operative times and fluid infusion were comparable between the two techniques.

## Abstract

Intraoperative bleeding during hepatectomy is primarily controlled through anaesthesiological interventions or surgical techniques such as Pringle maneuver (PM). Infrahepatic IVC clamping (IIVCC) is an alternative surgical technique to reduce central venous pressure and prevent retrograde hepatic venous bleeding. The aim of the meta-analysis was to compare IIVCC+PM with PM alone in terms of intraoperative outcomes and perioperative complications.

Medline, Cochrane Library, Scopus, Web of Science, and EMBASE were searched for comparative studies till 16.04.2024, resulting in 679 articles, of which eight studies met inclusion criteria. Data on patient demographics, surgical technique, and perioperative outcomes was assessed. Cochrane Risk of Bias 2.0 (RoB 2.0) Tool and Newcastle-Ottawa Scale (NOS) were used for risk of bias assessment.

Two randomized controlled trials, one prospective, and five retrospective cohort studies with 358 patients in IIVCC+PM and 397 patients in PM alone group were included. IIVCC+PM resulted in significantly greater CVP reduction, less intraoperative blood loss (MD (95% CI) = − 233.03 (− 360.48 to − 105.58), P < 0.001), and less intraoperative blood transfusion (OR (95% CI) = 0.38 (0.25 to 0.57), P < 0.001) compared to PM alone. The two groups had comparable total operative time, transection time and total intraoperative fluid infusion. Patients undergoing IIVCC+PM had significantly shorter length of stay (MD (95% CI) = − 0.63 days (− 1.21 to − 0.05 days), P = 0.03) and overall complication rates (OR (95% CI) = 0.63 (0.43–0.92), P = 0.02) compared to PM alone group.

The utilization of IIVCC along with PM during liver resection may be beneficial in reducing intraoperative bleeding and blood transfusion without adversely influencing operative times or perioperative outcomes compared to PM alone.

The online version contains supplementary material available at 10.1007/s00423-024-03344-6.