Which maneuver is done to temporarily stop inadvertent bleeding during cholecystectomy

Chitranjjan National Cancer Institute Kolkata - 2021

Medical & Surgical Nursing

Easy

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

The Pringle maneuver is a standard surgical technique for temporarily controlling hemorrhage during liver and gallbladder (cholecystectomy) surgeries.
It involves the compression of the hepatoduodenal ligament, which contains the portal triad (hepatic artery, portal vein, and common bile duct).
By occluding the hepatic artery and portal vein, the maneuver effectively stops blood inflow to the liver, allowing surgeons to manage bleeding from sources like the cystic artery or liver parenchyma.

Option A: The Patey maneuver is not related to abdominal surgery. It is a specific type of modified radical mastectomy.
Option C: The Kocher maneuver is used for surgical exposure, not hemostasis. It involves mobilizing the second part of the duodenum to access retroperitoneal structures like the head of the pancreas, distal common bile duct, and inferior vena cava.
Option D: Billroth I and Billroth II are not maneuvers but types of surgical reconstruction following a partial gastrectomy (removal of the stomach).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Surgical maneuvers for hemostasis as background academic context rather than a clinical decision trigger.
For an operating room nurse, knowing the Pringle maneuver is crucial for anticipating the surgeon's needs. This includes having the appropriate vascular clamps (e.g., a Satinsky or a large Rumel tourniquet) ready when significant bleeding is encountered during a cholecystectomy or liver procedure.
This knowledge helps the nurse understand the urgency of the situation and assist the team efficiently in a high-pressure environment.
What if bleeding continues even after applying the Pringle maneuver? This critical finding suggests the bleeding source is not from the hepatic artery or portal vein. The most likely culprits are the hepatic veins (draining into the IVC) or an aberrant hepatic artery (an anatomical variation). This would require a different surgical strategy, such as total vascular isolation of the liver or direct repair, and the nurse should be prepared for a more complex procedure.

How to Approach the Question

First, identify the key elements of the question: a 'maneuver' to 'stop bleeding' during a 'cholecystectomy' (gallbladder surgery).
The central task is to match a specific surgical procedure with its correct name and purpose.
Systematically review the options, recalling or looking up the function of each named maneuver.
Patey is associated with breast surgery.
Billroth is associated with stomach surgery.
Kocher is an abdominal maneuver, but its purpose is for exposure (mobilizing the duodenum), not primarily for hemostasis of the liver/gallbladder.

Concept Tested & Keywords

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