Isolated caudate lobectomy is a challenging operation for hepatobiliary surgeons. Unexpected massive hemorrhage is one of the major concerns for successful operation. To address the issue of bleeding control and prophylaxis during isolated caudate lobectomy is necessary. Our aim was to summarize the application of hepatic vascular exclusion in the operation for decreasing blood loss. 26 cases of isolated caudate lobectomy were reviewed. All the operations were accomplished successfully with satisfactory average blood loss (325.38ml) and without major post operative complications. Hepatic vascular exclusion was resorted to in nearly four fifths of the cases. Pringle maneuver, portal vein exclusion, total hepatic vascular exclusion, selective total hepatic vascular exclusion and selective regional total hepatic vascular exclusion were applied selectively. Hepatic vascular exclusion decreased blood loss during isolated caudate lobectomy effectively. Fully mobilization of the liver facilitates hepatic vascular exclusion. Certain precautionary measures and effective remedy for unexpected bleeding are necessary. Isolated caudate lobectomy should be carried out by experienced hepatobiliary surgeons.

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