Ischemic preconditioning versus intermittent clamping of portal triad in liver resection: A meta-analysis of randomized controlled trials

Aim To compare the clinical outcome of patients undergoing liver resection under ischemic preconditioning (IP) versus intermittent clamping (IC). Methods A systematic published work search was conducted to detect randomized controlled trials (RCT) comparing IP and intermittent clamping of the portal triad. A meta‐analysis was conducted to estimate postoperative morbidity and mortality, blood loss, transfusion requirement, and liver injury based on the levels of bilirubin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Meta‐analysis was performed using either the fixed‐effects model or random‐effects model. Results Five RCT published between 2006 and 2012 containing a total of 403 patients were eligible for final analysis. Meta‐analysis of operative time showed it was lower in the IP group than the IC group with weighted mean difference (WMD) of −18.23 (95% confidence interval (CI), −28.58 to −7.87; P = 0.0006). Meta‐analysis of ALT levels indicated lower levels in the IP group on postoperative days 3 and 7 (WMD on day 3: –45.27, 95% CI, −49.92 to −40.62; P