Sarely (Israelashvili) M et al. (2005) Use of transportal balloon catheter occlusion of the portal triad in prevention of bleeding during liver resection. J Surg Oncol 89: 39–42

Operative blood loss is an important consideration in resection of the liver, and is usually controlled by compression of the hepatoduodenal ligament. A recent report from Israel describes 20 years of experience using an alternative approach: transportal balloon catheter occlusion of the portal triad (TBCOPT).

The TBCOPT method involves insertion of a balloon catheter into the lumen of the lobar, sectoral or segmental portal vein branch, depending on which part of the liver is to be removed. The balloon is then inflated with saline, resulting in occlusion of the portal vein branch and compression of the corresponding artery. This temporary, selective occlusion minimizes bleeding while avoiding complete anoxia of the liver.

The recent study describes 35 liver resections, mostly for liver metastases from colorectal cancer, which were carried out using TBCOPT. There was no significant bleeding from the afferent vessels in 27 cases. Sudden bleeding from the hepatic artery occurred in the remaining eight cases and was addressed by a temporary interruption of the artery following dissection of the hepatoduodenal ligament. Operative mortality and postoperative complications were reported in two and six patients, respectively, although none of these cases was directly attributable to the balloon catheter.

The authors conclude that the TBCOPT method is technically feasible, and appropriate even in cirrhotic patients with low residual liver function.