{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T07:07:24Z","timestamp":1783840044703,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The risk of blood loss in liver surgery remains a recent concern. Recent investigations have shown that intraoperative hypovolemic phlebotomy (HP) is effective at reducing blood loss and transfusions during liver surgery. In this meta\u2010analysis, we seek to assess the effects of HP on patients undergoing liver surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Electronic databases, PubMed, Embase, and Web of Science, were searched from inception to January 2025, with an update in November 2025. Our eligibility criteria included randomized controlled trials (RCTs) or observational studies comparing HP to standard care in patients undergoing liver surgery. A random effects model was used for analysis pooling the mean differences (MD) and risk ratios (RRs) with corresponding 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 13 studies, with 4577 patients, were analyzed. Compared with the control group, the use of HP was associated with a lower incidence of perioperative RBC transfusion (RR: 0.55, 95% CI: [0.46 to 0.67],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001, and\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a018.50%). Subgroup analyses showed consistent results across different subgroups according to the type of surgery: liver resection subgroup (RR: 0.57, 95% CI: [0.43 to 0.75],\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a027.87%) and liver transplantation subgroup (RR: 0.52, 95% CI: [0.42 to 0.63],\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a018.74%) (\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      \u00a0=\u00a00.85), and study design: RCTs subgroup (RR: 0.65, 95% CI: [0.44 to 0.96],\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a014.15%) and the observational cohort studies subgroup (RR: 0.52, 95% CI: [0.40 to 0.67],\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a034.34%) (\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      \u00a0=\u00a00.34). Similarly, the use of HP significantly reduced the intraoperative RBC transfusions rate (RR: 0.46, 95% CI: [0.31 to 0.68],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001), postoperative RBC transfusions rate (RR: 0.60, 95% CI: [0.44 to 0.82],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001), and estimated blood loss (MD: \u2212237 mL, 95% CI: [\u2212383.43 to \u221290.98],\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) compared with the control group. Secondary and safety outcomes, such as central venous pressure, hospital stay duration, and overall complications, were comparable between the two groups. The GRADE assessment indicated that the certainty of evidence for perioperative RBC transfusions was high in the RCTs subgroup but low in the observational subgroup.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among patients undergoing liver surgery, the use of HP was associated with a lower blood transfusion rate and blood loss, while maintaining an acceptable safety profile. Further large clinical trials are necessary to clarify the exact mechanism involved.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70399","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T18:03:57Z","timestamp":1779905037000},"page":"1822-1834","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes After Intraoperative Hypovolemic Phlebotomy in Patients Undergoing Liver Surgery: A Meta\u2010Analysis"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2713-3233","authenticated-orcid":false,"given":"Mohamed Saad","family":"Sayed","sequence":"first","affiliation":[{"name":"Faculty of Medicine Beni\u2010Suef University  Beni Suef Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesma Khaled","family":"Shalaby","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahma Mahmoud","family":"Almetwaly","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arwa Mohamed Amer","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"College of Medicine University of Sharjah  Sharjah UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusof Mohamed","family":"Omar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2356-0751","authenticated-orcid":false,"given":"Ursula","family":"Abu Nahla","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Hebron University  Hebron Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Abokhozima","sequence":"additional","affiliation":[{"name":"General Surgery Department Faculty of Medicine Alexandria University  Alexandria Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hebatullah","family":"Abdelazeem","sequence":"additional","affiliation":[{"name":"Chair of Epidemiology Department of Health Science TUM School of Medicine and Health Technical University of Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1976.231.2.292"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hpb.12462"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","unstructured":"L.Baker S.Bennett J.Rekman et\u00a0al. \u201cHypovolemic Phlebotomy in Liver Surgery Is Associated With Decreased Red Blood Cell Transfusion \u201d (November 2018) http:\/\/www.sciencedirect.com\/science\/.","DOI":"10.26226\/morressier.596648e4d462b80290b52018"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102168.1998.00795.x"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i1.303"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10330\u2010019\u20100371\u20101"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2019.03.004"},{"key":"e_1_2_13_9_1","volume-title":"Blumgart\u2019s Surgery of the Liver, Biliary Tract and Pancreas, 2\u2010Volume Set \u2010 E\u2010Book","author":"Jarnagin W. 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