Modern concept of transfusiological support of extensive liver resections

• Solovyova I.N.
• German E. Cherkasov
• Bagmet N.N.

Abstract

Background. The use of high-tech methods of dissection of the liver parenchyma allowed to reduce the volume of blood loss during extensive resections, which requires a reassessment of the transfusiological support of the operation.

Aim - to formulate the features of transfusiological providing of extensive liver resections in the current state of the surgical process to improve its results.

Material and methods. A retrospective analysis of 374 patients with extensive liver resections for the period 2000-2019 was carried out: 282 were operated on in 2000-2012 (group 1). 92 in 2013-2019 (group 2). For dissection of parenchyma in 1^st group, clamps were used in 68.8% of cases, and a water scalpel was used in 23.8%. In the group 2. 31.5% - high-tech methods, in 39% -combined.

Results. The average blood loss in group 1 was 1302±80 ml, in the group 2 - 600±140 ml (p<0.001). The number of early postoperative complications, including biliary complications, decreased by 2 times, the postoperative bed-day decreased by 23%. The need for erythromass in the group 2 decreased by 2.5 times, in the FFP - by 1.7 times. The state of hemostasis during the operation was maintained by the introduction of 3-4 doses of FFP.

Conclusion. The introduction of high-tech and combined parenchymal dissection methods into the practice of hepatic surgery made it possible to reduce blood loss by 2.2 times, and fundamentally changed the conditions of transfusion support. The most relevant are preoperative autoplasma -donation and intraoperative reinfusion of autoerythrocytes.

Keywords:extensive liver resection, blood loss, high-tech and combined methods of parenchymal dissection, blood-saving technologies

References 

1.    Order of the Ministry of Health of the Russian Federation No. 1170n of October 28, 2020 «On approval of the procedure for providing medical care to the population in the profile of "transfusiology"». In: Official Internet portal of legal information. URL: http://pravo.gov.ru (date of access November 27, 2020)

2.    Poon R.T., Fan S.T., Wong J. Liver resection using a saline linked radiofrequency dissecting sealer for transection of the liver. J Am Coll Surg. 2005; 200: 308-13.

3.    Rahbari N.N., Koch M., Schmidt T., et al. Metaanalysis of the clampcrushing technique for transection of the parenchyma in elective hepatic resection: back to where we started? Ann Surg Oncol. 2009; 16: 630-9.

4.    Galperin E.I., Ignatjuk V.G. Liver resection «ad massam» modality in it’s malignant lesions in it’s malignant lesions. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2010; 15 (2): 18-23. (in Russian)

5.    Patyutko Yu.I., Sagaydak I.V., Kotel’nikov A.G., Polyakov A.N., Chuchuev E.S., Pylev A.L., et al. Liver resection: modern technologies for tumor lesion. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2010; 15 (2): 9-17. (in Russian)

6.    Skoriy D.I. How is the dissection of the hepatic parenchyma performed? Evaluation of the effectiveness of four techniques in seven randomized trials. Ukrainskiy zhurnal khirurgii [Ukrainian Journal of Surgery]. 2011; 13 (4): 260-5. (in Russian)

7. Vishnevsky V.A., Subbotin V.V., Efanov M.G., Ikramov R.Z., Kozyrin I.A. Prediction and prevention of massive intraoperative blood loss in extensive liver resections. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2012; 17 (1): 35-44. (in Russian)

8.    Henry S. ATLS 10th edition offers new insights into managing trauma patients. Bull. Am. Coll. Surg. 2018; June 1.

9.    Dag W. Viscoelastic haemostatic assays and fibrinogen concentration tests during haemodilution. Acta Anaesthesiol Scand. 2015; 59 (4): 544-5. DOI: https://doi.org/10.1111/aas.12478

10.    Sibylle A., Kozek-Langenecker S.A. Fluids and coagulation. Curr Opin Crit Care. 2015; 21 (4): 285-91. DOI: https://doi.org/10.1097/MCC.0000000000000219

11.    Rohde J.M., Dimcheff D.E., Blumberg N. et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA. 2014; 311: 1317-26.

12.    Seed C.R., Kiely P., Hoad V.C., Keller AJ.Refining the risk estimate for transfusion-transmission of occult hepatitis B virus. Vox Sang. 2017; 112 (1): 3-8.

13.    Solov’eva I.N., Charnaya M.A., Trekova N.A., Belov Yu.V., Axel’rod B.A., Rodionova M.N. Substantiation of preoperative autoplasma donation in cardiac surgery patients. Tromboz, gemostaz i reologiya [Thrombosis, Hemostasis and Rheology]. 2017; (1): 34-40. (in Russian)

14.    Zarivchatsky M.F., Mugatarov I.N., Kamenskikh E.D., Gavrilov O.V., Mal’ginov K.E., Kolevatov A.P., et al. Hemorrhage prevention and compensation in hepatic resection surgery. Permskiy meditsinskiy zhurnal [Permian Medical Journal]. 2013; 30 (5): 6-12. (in Russian)

15.    Bennett S., Baker L.K., Martel G., et al. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review. HPB (Oxford). 2017; 19 (4): 321-30. DOI: https://doi.org/10.1016/j.hpb.2016.12.008

16.    Krasnokutsky Yu.A., Kopchenko T.G. Autohemotransfusion as an alternative to donated blood in planned surgery. Meditsinskiy vestnik Severnogo Kavka-za [Medical Bulletin of North Caucasus]. 2007; (4): 14-7. (in Russian)

17.    Tsarev M.I., Rozhkov A.G., Karandin V.I., Az-barov A.A., Utlik Yu.A., Filippov A.V., et al. The use of bloodsaving technologies to prevent intraoperative blood loss during extensive liver resections. Vestnik zluzhby krovi Rossii [Bulletin of the Blood Service of Russia]. 2010; (2): 29-34. (in Russian)

18. Sukhorukov V.P., Gogolev N.V., Yuzhanin V.B., Rusinov V.M. Intraoperative normovolemic infusion-transfusion support of extended liver resections. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2012; 17 (2): 15-9. (in Russian)

19.    Pasechnik I.N., Skobelev E.I. Blood-saving technologies in surgery: new opportunities. Effektivnaya farmakoterapiya. Anesteziologiya i reanimatologiya [Effective Pharmacotherapy. Anesthesiology and Reanima-tology]. 2015; (12): 36-40. (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)