Our study aimed at assessing the changes of portal vein pressure, portal vein flow and hepatic arterial flow (HAF) in liver remnants ≤ 30% of the standard liver volume by reducing portal vein overflow via ligation of the splenic artery.

It has been reported that prevention of acute portal overpressure in small-for-size liver grafts leads to better postoperative outcomes. Accordingly, we aimed to investigate the feasibility of the technique of splenic artery ligation in a case series of patients subjected to major liver resections with evidence of small-for-size syndrome and whether the maneuver results in reduction of portal venous pressure and flow.

Inclusion Criteria:

• Adult patients
• American Society of Anesthesiologists (ASA) distribution I to III
• Patients scheduled for major liver resection (≥4 segments)

Exclusion Criteria:

• patients with extrahepatic disease
• patients with metastatic liver tumors

retrospective analysis of an internal hepatectomy database