Impact of Pringle Maneuver on Postoperative Gallbladder Diseases After Hepatectomy

Impact of Pringle Maneuver on the Occurrence of Postoperative Gallbladder Diseases After Hepatectomy: A Multicenter Retrospective Cohort Study

The liver is an organ with a rich blood supply. During liver surgery (hepatectomy), surgeons often temporarily clamp the blood vessels supplying the liver to maintain a clear surgical field and reduce bleeding. This common technique is known as the Pringle maneuver. However, this maneuver also temporarily cuts off the blood supply to the gallbladder. Currently, doctors debate whether to routinely remove a healthy gallbladder during liver surgery to prevent future gallbladder problems, or to preserve it.

The primary purpose of this multicenter retrospective cohort study is to evaluate whether using the Pringle maneuver during liver surgery increases the risk of patients developing gallbladder diseases (such as gallstones or inflammation) later on. Researchers will review the past medical records of patients who underwent liver surgery with their gallbladder preserved between January 2012 and January 2022. By comparing patients who had the Pringle maneuver with those who did not, the study aims to provide reliable clinical evidence to help surgeons make better decisions about whether to preserve or remove the gallbladder during liver surgery.

Study Overview

• Status: Recruiting
• Conditions: Gallbladder Diseases; Cholelithiasis
• Intervention / Treatment: Procedure: Pringle maneuver

Detailed Description

Hepatectomy is a primary curative treatment for various liver solid lesions. Given the liver's extensive vascular network, effective inflow occlusion is crucial during hepatectomy to minimize intraoperative blood loss and shorten operative time. The Pringle maneuver, which involves the temporary clamping of the hepatic artery and portal vein, is the most frequently utilized technique for this purpose. Despite its effectiveness in controlling hemorrhage, the Pringle maneuver inevitably induces ischemic-reperfusion injury to the hepatobiliary system and interrupts the blood supply to the gallbladder. This interruption may theoretically contribute to a higher risk of postoperative gallbladder diseases, including cholelithiasis and chronic cholecystitis.

In current clinical practice, the management of a disease-free gallbladder during hepatectomy remains controversial. Some surgeons advocate for simultaneous prophylactic cholecystectomy to prevent future gallbladder-related complications, whereas others prefer gallbladder preservation when no overt pathological changes are present. To date, robust evidence regarding the definitive impact of the Pringle maneuver on the incidence of postoperative gallbladder diseases is lacking.

This multicenter retrospective cohort study is designed to bridge this evidence gap. Clinical data will be retrospectively extracted for patients who underwent elective hepatectomy with gallbladder preservation across multiple major clinical centers in China from January 2012 to January 2022. The study will comprehensively evaluate and analyze baseline demographic profiles, preoperative laboratory indicators, tumor characteristics, intraoperative parameters (specifically the application and duration of the Pringle maneuver), and postoperative outcomes. The primary focus is to assess the occurrence of postoperative gallbladder diseases and identify potential risk factors associated with this complication. The findings are expected to provide high-quality, real-world evidence to guide surgical decision-making regarding gallbladder management during hepatectomy.

• Study Type: Observational
• Enrollment (Estimated): 2000

Contacts and Locations

• Study Contact: Name: Jiwei Huang; Phone Number: +86 18980606725; Email: huangjiwei@wchscu.cn
• Study Contact Backup: Name: Jun Ji; Phone Number: +86 18752433889; Email: jijun0317@163.com

Study Locations

• China
  • Anhui
    • Hefei, Anhui, China
      • Recruiting
      • The First Affiliated Hospital of University of Science and Technology of China
      • Contact: Dalong Yin; Phone Number: +86 18110984879; Email: huangjiwei@wchscu.cn
  • Chongqing Municipality
    • Chongqing, Chongqing Municipality, China
      • Recruiting
      • Xinqiao Hospital of Army Medical Universit
      • Contact: Lu Zheng; Phone Number: +86 15736202516; Email: huangjiwei@wchscu.cn
  • Guangdong
    • Guangzhou, Guangdong, China
      • Recruiting
      • Sun Yat-sen University Cancer Center
      • Contact: Dandan Hu; Phone Number: +86 13417108300; Email: huangjiwei@wchscu.cn
    • Guangzhou, Guangdong, China
      • Recruiting
      • Zhujiang Hospital of Southern Medical University
      • Contact: Jian Yang; Phone Number: +86 18349178834; Email: huangjiwei@wchscu.cn
  • Heilongjiang
    • Harbin, Heilongjiang, China
      • Recruiting
      • The First Affiliated Hospital of Harbin Medical University
      • Contact: Yong Ma; Phone Number: +86 13199452330; Email: huangjiwei@wchscu.cn
  • Hubei
    • Wuhan, Hubei, China
      • Recruiting
      • Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
      • Contact: Peng Zhu; Phone Number: +86 18875435288; Email: huangjiwei@wchscu.cn
  • Jiangsu
    • Nanjing, Jiangsu, China
      • Recruiting
      • Nanjing Drum Tower Hospital
      • Contact: Decai Yu; Phone Number: +86 18036198729; Email: huangjiwei@wchscu.cn
  • Tianjin Municipality
    • Tianjin, Tianjin Municipality, China
      • Recruiting
      • Tianjin Medical University Cancer Institute and Hospital
      • Contact: Tianqiang Song; Phone Number: +86 18622221077; Email: huangjiwei@wchscu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of consecutive patients who underwent elective hepatectomy for hepatic solid lesions with their gallbladder preserved at multiple participating clinical centers in China between January 2012 and January 2022.

Description

Inclusion Criteria:

• Aged 18 to 85 years.
• Definitive diagnosis of hepatic solid lesions confirmed by imaging (such as CT, MRI, or ultrasound) and/or pathology.
• Underwent elective hepatectomy with gallbladder preservation.
• Preoperative liver function evaluated as Child-Pugh class A or B.
• Preoperative American Society of Anesthesiologists (ASA) physical status classification of I, II, or III.

Exclusion Criteria:

• Preoperative evaluation indicating pre-existing biliary tract diseases (e.g., cholelithiasis, biliary inflammation, neoplastic lesions).
• History of previous upper abdominal surgery.
• Application of non-hepatic inflow occlusion methods during surgery (e.g., hemihepatic vascular occlusion, selective segmental vascular occlusion).
• Personal history of long-term use of hormone replacement therapy, somatostatin and its analogues, or oral contraceptives.
• Loss to follow-up or missing critical data postoperatively.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pringle Maneuver Group; Patients who underwent elective hepatectomy with gallbladder preservation and received Pringle maneuver during the surgery.	Procedure: Pringle maneuver; A surgical technique utilized during hepatectomy that involves the temporary clamping of the hepatic hilum to control and reduce intraoperative blood loss.; Other Names: Hepatic inflow occlusion
Non-Pringle Maneuver Group; Patients who underwent elective hepatectomy with gallbladder preservation but did not receive Pringle maneuver or any other specific vascular occlusion during the surgery.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cumulative Incidence of Postoperative Gallbladder Diseases	The cumulative incidence of gallbladder diseases after hepatectomy. Gallbladder diseases are defined as any of the following conditions confirmed by postoperative imaging or pathology: gallstones with or without cholecystitis (ICD-10: K80.0-K80.2); acute or chronic cholecystitis (ICD-10: K81.0-K81.9); other gallbladder diseases such as polyps, cholesterolosis, or adenomyomatosis (ICD-10: K82.0-K82.9); and gallbladder malignancy (ICD-10: C23). The cumulative incidence rate will be estimated using the Cumulative Incidence Function (CIF) to appropriately account for competing risks.	Up to 14 years (From the date of surgery to the follow-up cutoff date in January 2026)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Risk Factors Associated with Postoperative Gallbladder Diseases	Identification of independent risk factors (including patient baseline demographics, tumor characteristics, and surgical parameters such as the application of the Pringle maneuver) associated with the development of postoperative gallbladder diseases. To appropriately account for competing events (e.g., death prior to the onset of gallbladder disease), multivariable competing risk regression analysis, specifically the Fine-Gray subdistribution hazard model, will be utilized.	Up to 14 years (From the date of surgery to the follow-up cutoff date in January 2026)

Collaborators and Investigators

• Sponsor: West China Hospital
• Collaborators: Sun Yat-sen University; Tongji Hospital; The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School; Tianjin Medical University Cancer Institute and Hospital; Southern Medical University, China; The First Affiliated Hospital of University of Science and Technology of China; First Affiliated Hospital of Harbin Medical University; Army Medical University, China

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): August 1, 2026

Study Registration Dates

• First Submitted: March 1, 2026
• First Submitted That Met QC Criteria: March 1, 2026
• First Posted (Actual): March 5, 2026

Study Record Updates

• Last Update Posted (Actual): March 5, 2026
• Last Update Submitted That Met QC Criteria: March 1, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Hepatectomy; Pringle maneuver; Hepatic inflow occlusion
• Additional Relevant MeSH Terms: Digestive System Diseases; Biliary Tract Diseases; Gallbladder Diseases; Cholelithiasis
• Other Study ID Numbers: JHuang20236

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The decision to share individual participant data (IPD) has not yet been made. Because this is a multicenter study involving patient records from various institutions, data sharing requires consensus, formal data-sharing agreements, and institutional ethical approvals from all participating centers. A final decision will be made prior to the publication of the study results.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No