Safety of Single Continuous Pringle Maneuver During HHA Enucleation: A Retrospective Cohort Study

Objective: To evaluate the impact of different Pringle maneuver techniques (continuous vs. intermittent) and occlusion durations on postoperative liver function and surgical outcomes after hepatic hemangioma(HHA) enucleation. Methods: A total of 268 consecutive patients who underwent laparoscopic or robot-assisted HHA enucleation between January 1, 2011, and November 1, 2024, were retrospectively reviewed; 129 of them met the inclusion criteria and constituted the final study cohort.They were divided into four groups according to the Pringle maneuver and its duration. Group A, B, C had continuous Pringle maneuvers for <20 min, 20 - 40 min, 40 - 70 min respectively, and Group D had intermittent multiple Pringle maneuvers with 40 - 70 min cumulative occlusion. Post - operative complications, liver function changes, and hospital stay were compared. Results: There were no significant differences in age, gender, most parameters among groups (P > 0.05), except larger hemangioma diameter in Group C (P < 0.05). Group D had longer operation time and more blood loss (P < 0.05). Blood transfusion volume had no significant difference. Only Group C had elevated GGT on postoperative Day 3 (P < 0.05). Conclusion: For normal liver function patients having HHA enucleation, continuous Pringle maneuver up to 60 min is safe, simplifies the procedure, reduces blood loss and operation time, with comparable postoperative recovery to intermittent occlusions.