Vascular inflow occlusion of the liver is by -: (A) Clamping the hepatic artery, (B) Occluding the portal vein, (C) Clamping the hepatic veins, (D) The Pringle manoeuvre
Answer is D. • Total clamping of the hepatic pedicle, by placing an atraumatic clamp across the foramen of Winslow.
• Appropriate-sized vascular clamp or loop snare easily controls hemorrhage from either the portal vein or the hepatic arteries.
• Inflow occlusion durations of up to 30 minutes can be tolerated safely in cirrhotic livers and possibly up to 60 minutes in early disease.
• If prolonged occlusion is required, intermittent clamping can be used with repeated clampings of 10-20 minutes duration, each followed by 5 minutes declamping.