Abstract
BACKGROUND: The Pringle maneuver remains a widely used technique in hepatic surgery with varying opinions on its effects on postoperative outcomes and survival, requiring evidence-based evaluation of its impact on liver function and long-term results. AIMS: The aim of this study was to evaluate the impact of the intermittent Pringle maneuver on postoperative liver function and survival in hepatectomy patients, focusing on early dysfunction markers as prognostic factors. RESULTS: In this retrospective cohort of 198 patients (106 women and 92 men; mean age, 59 years), the Pringle group showed longer surgical times (226.87±82.18 vs. 184.00±80.90 min, p<0.001) and extended intensive care unit stays (4.02±2.1 vs 3.11±1.9 days, p=0.026), but lower bilirubin levels (2.18±0.33 vs. 3.13±0.39 mg/dL, p=0.049). Multivariate analysis revealed that the Pringle maneuver reduced mortality risk (hazard ratio [HR]=0.540, 95% confidence interval [95%CI]: 0.333-0.876, p=0.013). Early liver dysfunction markers strongly predicted worse outcomes: elevated bilirubin nearly doubled mortality risk (HR 1.975, 95%CI 1.100-3.545, p=0.023), and decreased prothrombin activity tripled it (HR 3.055, 95%CI 1.839-5.075, p<0.001). CONCLUSIONS: While the Pringle maneuver extends operative time and intensive care unit stay, it demonstrates a protective effect on survival. Early postoperative liver dysfunction strongly predicts poor outcomes, emphasizing the importance of careful postoperative monitoring regardless of vascular control strategy. These findings suggest that a controlled intermittent Pringle maneuver offers survival benefits when properly timed.