ABSTRACT
The risk of hemorrhage has been the major obstacle to the safety of hepatic resection. While this remains a concern, blood loss and transfusion requirements have been markedly reduced as a result o f changes in operative technique. Although portal triad clamping reduces hepatic arterial and portal venous bleeding during parenchymal transection, this has no effect on bleeding from the hepatic veins which are usually the major source of blood loss. Inflow and outflow vascular control be fore parenchymal transection, low central venous pressure anesthesia, and anatomi cally based resections, are all important components of contemporary hepatic resection and play a role in minimizing operative blood loss. Total vascular isolation, a funda mentally different approach that is required in few cases, has not been shown to lower intraoperative blood loss or transfusion requirements.
