The manoeuvre (marked with an asterisk) shown in the following image is
Pringle
The manoeuvre shown is the Pringle manoeuvre: clamping or digitally compressing the hepatoduodenal ligament carrying the portal triad - portal vein, hepatic artery proper and common bile duct - by passing a finger through the foramen of Winslow. This occludes hepatic inflow to control bleeding from a lacerated liver or during hepatectomy. Warm ischaemia is tolerated for about 15 to 20 minutes at a time, so intermittent clamping is preferred. If bleeding persists despite a correct Pringle, the source is the hepatic veins or retrohepatic inferior vena cava, or an aberrant left hepatic artery.
The Mattox manoeuvre is a left medial visceral rotation exposing the suprarenal aorta. The Kocher manoeuvre mobilises the duodenum by incising its lateral peritoneal attachment to expose the pancreatic head, distal bile duct and vena cava. The shoe-shine manoeuvre belongs to antireflux surgery, sliding the wrapped fundus back and forth to confirm a loose, correctly oriented Nissen fundoplication.
Key point: Pringle controls inflow only; persistent bleeding after clamping points to hepatic venous or caval injury.
Important Questions from Hepatobiliary & Pancreatic Surgery
Which among the following are complications of liver trauma?
1. Liver abscess
2. Biliary fistula
3. Portal thrombosis
4. Liver failure
Select the correct answer using the code given below.
Which of the following are local complications of acute pancreatitis?
1. Pseudocyst
2. Pleural effusion
3. Ileus
4. Acute fluid collection
Select the correct answer using the code given below.
Which of the following are risk factors for the development of pancreatic cancer?
1. Cigarette smoking
2. Diabetes mellitus
3. Caucasian ethnicity
4. Male gender
Select the correct answer using the code given below.
Which of the following are options for management of a pancreatic pseu- docyst?
1. Pancreaticoduodenectomy
2. Cystogastrostomy
3. Percutaneous drainage
4. Endoscopic drainage
Select the correct answer using the code given below :
- Which of the following statements regarding hepatic adenomas are correct? 1. They are almost exclusively seen in females aged 25-50 years 2. They are associated with use of oral contraceptive pills 3. They do not have any malignant potential 4. Majority are detected incidentally on imaging Select the correct answer using the code given below :
