During hepatic resection, the surgeon intermittently occludes the hepatoduodenal ligament with a soft clamp to reduce bleeding. Which statement about this manoeuvre is correct?

• A It is contraindicated in cirrhotic livers under any circumstance
• B It blocks both portal inflow and hepatic venous outflow simultaneously
• C It occludes inflow only, leaving retrograde bleeding from hepatic veins unaffected ✓
• D Continuous clamping is safer than intermittent clamping for liver parenchyma

Explanation

The Pringle manoeuvre compresses the portal vein and hepatic artery within the free edge of the lesser omentum, controlling all inflow but doing nothing for back-bleeding from hepatic veins, hence low central venous pressure anaesthesia is used alongside it. Warm ischemia is generally limited to periods around 15 to 20 minutes with intervals of reperfusion, and cirrhotic livers tolerate it less well but intermittent clamping remains usable rather than absolutely forbidden.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.

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