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Cirrhotic livers can tolerate 30 minutes ischaemia at normal environmental temperature.

OBJECTIVE
To find out the safe time limit for Pringle's manoeuvre (compression of the hepatic artery and portal vein in the gastrohepatic omentum to halt bleeding) under normal environmental conditions for limited resection of cirrhotic livers.


DESIGN
Prospective open study.


SETTING
University hospital, Japan.


SUBJECTS
Pringle's manoeuvre was used in 73 consecutive patients with hepatocellular carcinoma and cirrhosis (Child's classification: A = 44, B = 24, and C = 5), and in 20 patients it was not used (Child's classification: A = 11, B = 5, and C = 4).


INTERVENTIONS
Limited hepatic resections were done with the duration of Pringle's manoeuvre ranging from 5 to 41 minutes. 15 patients simultaneously underwent 17 other abdominal operations.


MAIN OUTCOME MEASURES
Child's classification, blood loss during operation, and duration of hepatic ischaemia.


RESULTS
The morbidity and mortality with Pringle's manoeuvre were 1 (2%) and 0 in Child's A cirrhosis, 7 (29%) and 2 (8%) in Child's B cirrhosis, and 2 (40%) and 1 (20%) in Child's C cirrhosis. The higher rates in class B and C patients were ascribed to the amount of blood loss rather than to Pringle's manoeuvre.


CONCLUSION
Pringle's manoeuvre can be used safely for up to 30 minutes during limited resection of the cirrhotic liver.