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Abdominal Injuries
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
The only effective and reliable manoeuvre for initial haemorrhage control in difficult cases is the Pringle manoeuvre. The Pringle manoeuvre controls the hepatic vascular inflow – the portal vein and the hepatic artery – which can be found within the substance of the free edge of the lesser omentum (the gastro-hepatic ligament) in addition to the common bile duct (CBD): portal vein posterior and CBD and hepatic artery in front. This is manually palpated by sliding the left index finger into the foramen of Winslow (just below the liver), which is the opening to the lesser sac (Figure 10.4). The free edge may be initially pinched between the left index finger and thumb, or a small window may be opened in the lesser omentum (medial to the structures to avoid damaging them), and a Foley catheter/vessel loop/any soft silicone tube double-looped around them for control. The Pringle manoeuvre may be kept in situ for about 10–20 minutes (without preconditioning) in severe trauma (assuming normal liver function) before severe hepatic ischaemia occurs. But as with the aorta, declamp it as soon as feasible.
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
Are you aware of any techniques that can be used to control bleeding from a damaged liver?The Pringle manoeuvre can be performed for up to 1 hour to control the bleeding and assess the damage; this involves soft clamping of the portal vein, hepatic artery and common bile ductSupracoeliac aortic clamping can also be considered in extremisA venovenous bypass (common femoral vein to axillary vein) can be done for venous injuryConsider use of topical haemostatic agents
Surgery and traumatology: Surgical management of severely injured patients when resources are limited
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
More severe injuries may require more extensive operations. These require both good access and temporary reduction of bleeding for visualisation. Access is achieved by maximal proximal extension of the incision, cutting the ligaments, and retracting the liver downwards with packing above. Temporary reduction of blood flow is achieved by the Pringle manoeuvre (vascular clamp on the hepatoduodenal ligament, opening it every 20 minutes). After that, carefully separate the edges of the injury and achieve haemostasis by ligation, suture or clips. If part of the liver is smashed or partly ‘torn off’, it can be resected as a debridement with removal of severely damaged or devascularised tissue and careful haemostasis (according to the principles above) on the surface of the resection. Drains should always be used.
Radical nephrectomy and intracaval thrombectomy for advanced renal cancer with extensive inferior vena cava involvement utilising cardiopulmonary bypass and hypothermic circulatory arrest: Is it worthwhile?
Published in Arab Journal of Urology, 2018
Hosam Serag, Jonathan M. Featherstone, David F. Griffiths, Dheeraj Mehta, John Dunne, Owen Hughes, Philip N. Matthews
Currently, we have changed this technique for level III tumours (above hepatic veins and below diaphragm), we have stopped using a thoraco-abdominal approach and we aim to mobilise the liver with help of liver surgeons, use a Pringle manoeuvre soft clamp and a clamp on IVC just under the diaphragm and above the tumour thrombus, manipulate the thrombus below the hepatic veins, then apply a second clamp across the IVC below the hepatic veins to avoid using CPB, and the number of cases on CPB has decreased over years.
Microwave-assisted liver resection vs. clamp crushing liver resection in cirrhosis patients with hepatocellular carcinoma
Published in International Journal of Hyperthermia, 2018
Zu-Bing Chen, Feng Qin, Zi Ye, Shi-Qiang Shen, Wei Li, You-Ming Ding, Qin-Yong Hu, Yi Ma
CC-LR was performed following the technique described by Zhou et al. [25]. Briefly, a modified right or bilateral subcostal incision was performed under general anaesthesia. The peritoneal cavity was examined, and intraoperative ultrasound was performed to reveal any previously undetected lesions. The liver was then mobilised based on lesion size and site. The Pringle manoeuvre was carried out for 15 min each time at 5-min intervals. A drain was placed at the resection site.