- Suturing or ligation
- Large or persistent bleeders are controlled with figure-of-eight sutures, vessel ligation, or clips
- Often used for branches of hepatic veins or portal triad structures
- Energy devices
- Bipolar diathermy and argon beam coagulator used to coagulate bleeding points over wide surfaces
- Argon plasma provides a non-contact coagulative effect and is useful for superficial haemostasis
- Stapling devices
- Vascular staplers can control large hepatic veins or segmental inflow vessels during anatomical resections
- Direct pressure and packing
- Gauze, swabs, or haemostatic sponges applied with pressure for oozing areas
- In trauma or uncontrolled bleeding, liver may be packed as part of damage control surgery
- Pharmacological adjuncts
- Tranexamic acid may reduce bleeding by inhibiting fibrinolysis
- Reversal of coagulopathy with plasma, platelets, or specific factor replacement as needed
- Topical haemostatic agents
- Fibrin glue, thrombin-soaked sponges, oxidised cellulose (Surgicel), gelatin matrix (FloSeal) applied to raw liver surface
- Help seal small vessels and bile ducts and support clot formation
- Pringle manoeuvre
- Temporary occlusion of the portal triad (hepatic artery, portal vein, bile duct) in the hepatoduodenal ligament using a vascular clamp or tape
- Reduces inflow and allows a bloodless field during parenchymal transection
- Can be applied intermittently (e.g. 10 minutes with 5-minute breaks)