In:
Hepatology Research, Wiley, Vol. 44, No. 8 ( 2014-08), p. 878-887
Abstract:
To compare the clinical outcome of patients undergoing liver resection under ischemic preconditioning ( IP ) versus intermittent clamping ( IC ). Methods A systematic published work search was conducted to detect randomized controlled trials ( RCT ) comparing IP and intermittent clamping of the portal triad. A meta‐analysis was conducted to estimate postoperative morbidity and mortality, blood loss, transfusion requirement, and liver injury based on the levels of bilirubin, aspartate aminotransferase ( AST ) and alanine aminotransferase ( ALT ). Meta‐analysis was performed using either the fixed‐effects model or random‐effects model. Results Five RCT published between 2006 and 2012 containing a total of 403 patients were eligible for final analysis. Meta‐analysis of operative time showed it was lower in the IP group than the IC group with weighted mean difference ( WMD ) of −18.23 (95% confidence interval ( CI ), −28.58 to −7.87; P = 0.0006). Meta‐analysis of ALT levels indicated lower levels in the IP group on postoperative days 3 and 7 ( WMD on day 3: –45.27, 95% CI , −49.92 to −40.62; P 〈 0.00001; I 2 = 0%; WMD on day 7: –24.33, 95% CI , −28.04 to −20.62; P 〈 0.00001; I 2 = 0%). Meta‐analyses revealed no significant difference in blood loss, transfusion requirement, mortality, morbidity, ischemic duration, hospital stay, AST and bilirubin levels on postoperative days 1, 3 and 7, and ALT levels on postoperative day 1 between IP and IC groups. Conclusion On currently available evidence, IP does not offer a satisfying benefit to patients undergoing hepatic resection. However, they have lower operative time and less liver injury after liver resections.
Type of Medium:
Online Resource
ISSN:
1386-6346
,
1872-034X
DOI:
10.1111/hepr.2014.44.issue-8
Language:
English
Publisher:
Wiley
Publication Date:
2014
detail.hit.zdb_id:
2006439-1
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