Reference : Consequences of Pneumoperitoneum on Liver Ischemia During Laparoscopic Portal Triad C...
Scientific journals : Article
Human health sciences : Gastroenterology & hepatology
Human health sciences : Surgery
http://hdl.handle.net/2268/80526
Consequences of Pneumoperitoneum on Liver Ischemia During Laparoscopic Portal Triad Clamping in a Swine Model.
English
Nsadi, Berthier [> > > >]
Gilson, Nathalie mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie abdominale- endocrinienne et de transplantation >]
Pire, Emilie [> > > >]
Cheramy, J. P. [> >]
Pincemail, Joël mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie cardio-vasculaire >]
Scagnol, Irène mailto [Centre Hospitalier Universitaire de Liège - CHU > > Anatomie pathologique >]
Meurisse, Michel mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie abdominale- endocrinienne et de transplantation >]
Defraigne, Jean mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie cardio-vasculaire >]
Detry, Olivier mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie abdominale- endocrinienne et de transplantation >]
Mar-2011
Journal of Surgical Research
Academic Press
166
1
e35-e43
Yes (verified by ORBi)
International
0022-4804
1095-8673
New York
NY
[en] Liver surgery ; ischemia ; abdominal surgery ; liver resection ; laparoscopy ; minimal invasive ; metastases ; cancer ; complication
[en] BACKGROUND: Portal triad clamping (PTC) may be required during laparoscopic liver resection to limit blood loss. The aim of this study was to test in a swine model the hypothesis that during laparoscopic PTC, increased intraperitoneal pressure may alter hepatic vein reverse circulation, inducing a more severe hepatic ischemia compared with PTC performed in laparotomy. METHODS: Fifteen pigs were randomized into three groups: laparoscopy (1 h of pneumoperitoneum at 15 mmHg and 3 h of surveillance), open PTC (1 h PTC through laparotomy and 3 h of reperfusion), and laparoscopic PTC (1 h PTC with 15 mmHg pneumoperitoneum and 3 h of reperfusion). PTC was performed under mesenteric decompression using a veno-venous splenofemoral bypass. Hepatic partial oxygen tension and microcirculatory flow were continuously measured using a Clarke-type electrode and a laser Doppler flow probe, respectively. Liver consequences of PTC was assessed by right atrium serum determination of transaminases, creatinine, bilirubin, INR, and several ischemia/reperfusion parameters, drawn before PTC (T0), before unclamping (T60), and 1 (T120) and 3 h after reperfusion (T240). Histology was performed on T240 liver biopsies. RESULTS: Compared with open PTC, laparoscopic PTC produced a more rapid and more severe decrease in hepatic oxygen tension, indicating a more severe tissular hypoxia, and a more severe decrease in hepatic microcirculatory flow, indicating a decrease in hepatic backflow. At T240, the laparoscopic PTC livers suffered from a higher degree of hepatocellular damage, shown by higher transaminases and increased necrotic index at pathology. CONCLUSIONS: These results indicate that in this pig model, laparoscopic PTC induces a more severe liver ischemia, related to decreased hepatic oxygen content and decreased hepatic backflow. If confirmed by clinical studies, these results may indicate that caution is necessary when performing prolonged PTC during laparoscopic hepatic resection, particularly in cirrhotic or steatotic livers.
Professionals ; Students ; General public
http://hdl.handle.net/2268/80526
10.1016/j.jss.2010.10.033
Copyright (c) 2010 Elsevier Inc. All rights reserved.

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