STEP 5Vascular ligation

The wound may require enlargement to visualize the source of bleeding by utilizing finger-fracture technique and retractors (hepatotomy). Bleeding vessels can be controlled using sutures, surgical clips, and electrocautery. However, deep stitches, which could lead to ischemic areas, should be avoided.

While a Pringle maneuver might be required, prolonged pedicle clamping must be avoided whenever possible as it may aggravate ischemic injury caused by hypotension. If pedicle clamping longer than 30min is needed, intermittent clamping is recommended (15min of clamping and 5min of reperfusion).

Hepatic defects can be filled by vascularized omentum (omentoplasty). This helps to eliminate dead space, tamponades venous oozing and may reduce the risk of a significant bile leakage.

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How to Stay Young

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