Grasping at straws

“An assistant held the portal vein and hepatic artery between a finger and thumb…’

James Hogarth Pringle, Annals of Surgery

Cholecystectomy, the removal of the gallbladder is a common operation. It is a bread and butter procedure for all general surgeons. It can also one of the most challenging. Just below the liver, alarmingly close to the gallbladder, are several vital tubes and a number of large blood vessels. Uncontrolled bleeding here can be sudden, torrential and difficult to deal with safely. Both patient and surgeon can be in a lot of trouble. However, if you clamp or just grab the hepatoduodenal ligament anterior to the foramen of Winslow you might just save the situation. This will control the hepatic vascular inflow. This is referred to as Pringle’s manoeuvre and it will buy you 15 minutes to get out of your surgical misery. James Hogarth Pringle was an English born Australian surgeon who described his technique in a 1909 in an Annals of Surgery publication. Just don’t confuse him with George Hogarth Pringle a Scottish born Australian surgeon, who after training under Lord Lister in Edinburgh, introduced Listerian antisepsis to Australia. #oops #letsmakelemonade