Liver hanging maneuver versus conventional approach for open hepatectomy: a meta-analysis

Abstract Background This study aimed to compare the safety and efficacy of the liver hanging maneuver (LHM) versus conventional approach for open hepatectomy. Methods A comprehensive medical literature search was performed. Perioperative outcomes and long-term survival outcomes were reported. Subgroup analyses were conducted according to surgical approaches, modification of LHM, geographical region and indications for liver resection. Results A total of 16 studies including 1109 patients were enrolled. The LHM was performed on 471 (37%) patients. The pooled outcomes showed hepatectomy with the LHM was associated with less estimated blood loss [standard mean difference (SMD): −0.77, P P  = 0.003], less transection time (SMD: −0.68, P  = 0.01), shorter duration of hospitalization (SMD:−0.19, P  = 0.004), lower total complication rate (OR: 0.63, P  = 0.008) and longer overall survival [hazard ration (HR): 0.70, P  = 0.002] compared to conventional open hepatectomy. Subgroup analyses showed similar outcomes to overall analyses. Conclusions The present meta-analysis suggested that the LHM was a safe and feasible alternative to conventional open hepatectomy with better perioperative and long-term outcomes. It was unnecessary to combine the LHM with anterior approach (AA) in consideration of perioperative outcomes.