Ting An Jie Liu Liwei Feng ^*

• West China Hospital, Sichuan University, Chengdu, China

The control of bleeding during laparoscopic liver resection (LLR) is still a focus of research. However, the advantages of the main bleeding control methods, including total hepatic inflow occlusion (TIO) versus hemihepatic inflow occlusion (HIO), during LLR remain controversial. The purpose of this meta-analysis was to compare the clinical outcomes of patients with TIO and HIO. This meta-analysis searched the Medline, PubMed, Web of Science, Embase, Ovid and Cochrane Library databases. The languages of the studies were restricted to English, and comparative studies of TIO and HIO patients during LLR were included. The primary outcome was to compare the intraoperative details, such as the operative time, occlusion time and volume of blood loss, between the two groups. Secondary outcomes included conversion, overall complications, liver failure, biliary leakage, ascites, pleural effusion and hospital stay. Five studies including 667 patients, 419 (62.82%) of whom received TIO and 248 (37.18%) of whom received HIO, were included in the analysis. The demographic data, including age, sex, hemoglobin, total bilirubin, albumin, and AFP, were comparable. There were no significant differences in operative time, occlusion time, volume of blood loss, conversion, overall complications, liver failure, biliary leakage, hemorrhage, ascites or pleural effusion. The hospital stay in HIO patients was significantly shorter than that in TIO patients (MD, 0.60; 95% CI, 0.33 to 0.87; p< 0.0001; I2 =54%). The blood loss of patients with liver cirrhosis in the TIO group was significantly less than that in the HIO group (MD, -107.63; 95% CI, -152.63 to -62.63; p<0.01; I2 =27%). Both the TIO and HIO methods are safe and feasible for LLR. Compared with HIO, TIO seems to have less blood loss in cirrhotic patients, which demands further research, especially multi-center randomized controlled trials, to verify this result in the future.