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Published in:

01-11-2006

Effect of Portocaval Shunt on Residual Extreme Small Liver after Extended Hepatectomy in Porcine

Authors: HongSheng Wang, MD, PhD, Nobuhiro Ohkohchi, MD, PhD, Yoshitaka Enomoto, MD, Masahiro Usuda, MD, Shigehito Miyagi, MD, Hiroo Masuoka, MD, Satoshi Sekiguchi, MD, Naoki Kawagishi, MD, Keisei Fujimori, MD, Akira Sato, MD, Susumu Satomi, MD, PhD

Published in: World Journal of Surgery | Issue 11/2006

Abstract

Background

When residual liver volume is extremely small after extended hepatectomy, postoperative hepatic failure may ensue. The cause of the hepatic failure is likely associated with the portal hypertension after hepatectomy. We investigated the effects of portocaval shunt on portal hypertension in producing sinusoidal microcirculatory injury after extended hepatectomy in pigs.

Methods

Fourteen pigs were divided into two groups: a group without a shunt, in which extended hepatectomy was carried out (i.e., residual volume was 17% of the whole liver), and a group with a shunt, in which extended hepatectomy was carried out and a portocaval shunt was inserted. The portocaval shunt was placed by side-to-side anastomosis between the portal vein and the inferior vena cava.

Results

In the group without a shunt, all pigs died of hepatic failure within postoperative day 3. In the group with a shunt, all pigs were alive for more than 4 days, and 4 pigs survived longer than 7 days. Portal vein pressure after hepatectomy was 15.9 ± 3.8 mmHg in the group without a shunt and 10.5 ± 0.6 mmHg in the group with a shunt (P < 0.01). The portal vein flow after 83% hepatectomy in the group without a shunt increased significantly more than at laparotomy and in the group with a shunt (P < 0.01). In the group without a shunt, remarkable destruction of the sinusoidal lining and edema of the portal triad and hydropic change of hepatocytes were observed 1 hour after hepatectomy, but these findings were not observed in the group with a shunt.

Conclusions

These results indicate that, after extended hepatectomy, overload of portal flow is one of the most significant risk factors of hepatic failure by sinusoidal microcirculatory injury.

Casavilla FA, Marsh JW, Iwatsuki S, et al. Hepatic resection and transplantation for peripheral cholangiocarcinoma. J Am Coll Surg 1997;185:443–451CrossRef

Aronsen KF, Grundsell H, Johansson BW, et al. Hemodynamic effects of partial hepatectomy in dogs. Acta Chir Scand 1969;135:320–324PubMed

Oliver RH, Sutton PM. The effects of partial hepatectomy on portal pressure in rats. Br J Surg 1966;53:138–141PubMed

Lee SS, Hadengue A, Girod C, et al. Reduction of intrahepatic vascular space in the pathogenesis of portal hypertension. In vitro and in vivo studies in the rat. Gastroenterology 1987;93:157–161PubMed

Nagasue N, Yukaya H, Ogawa Y, et al. Portal pressure following partial to extensive hepatic resection in patients with and without cirrhosis of the liver. Ann Chir Gynaecol 1983;72:18–22PubMed

Kanematsu T, Takenaka K, Furuta T, et al. Acute portal hypertension associated with liver resection. Analysis of early postoperative death. Arch Surg 1985;120:1303–1305PubMed

Sirinek KR, Thomford NR. The effect of vasopressin on portal hypertension following hepatectomy. Surg Gynecol Obstet 1974;139:573–577PubMed

Stone HH, Long WD, Smith RB 3rd, et al. Physiologic considerations in major hepatic resections. Am J Surg 1969;117:78–84PubMedCrossRef

Ueno S. An experimental study on the correlation between hepatic hemodynamics and ultrastructural and immunohistochemical changes of sinusoidal endothelial cells after major hepatectomy. Jpn J Surg 1994;95:248–258

10.

Ueno S, Kobayashi Y, Kurita K, et al. Effect of prior portosystemic shunt on early hepatic hemodynamics and sinusoids following 84% hepatectomy in dogs. Res Exp Med 1995;95:1–8

11.

Koga A, Fukuyama T, Momii S. Subcutaneous transposition of the spleen enhances the survival rate following 90% hepatectomy in rats. Experientia 1989;45:457–459PubMedCrossRef

12.

Fukuchi T, Hirose H, Onitsuka A, et al. Effects of portal-systemic shunt following 90% partial hepatectomy in rats. J Surg Res 2000;89:126–131PubMedCrossRef

13.

Szawlowski AW, Saint-Aubert B, Gouttebel MC, et al. Experimental model of extended repeated partial hepatectomy in the dog. Eur Surg Res 1987;19:375–380PubMed

14.

Mitsumoto Y, Dhar DK, Yu L, et al. FK506 with portal decompression exerts beneficial effects following extended hepatectomy in dogs. Eur Surg Res 1999;31:48–56PubMedCrossRef

15.

Wang HS, Enomoto Y, Usuda M, et al. Excessive portal flow causes graft nonfunction in small size liver transplantation: an experimental study in pigs. Transplant Proc 2005;37:407–408PubMedCrossRef

16.

Court FG, Laws PE, Morrison CP, et al. Subtotal hepatectomy: a porcine model for the study of liver regeneration. J Surg Res 2004;16:181–186CrossRef

17.

Atkinson DE, Chapman AG. The adenylate energy charge in the study of enzymes in vitro. Methods Enzymol 1979;55:229–235PubMedCrossRef

18.

Seya K, Ohkohchi N, Watanabe N, et al. Rapid fluorometric assay for mitochondrial proton adenosine triphosphatase activity for assessment of viability of liver graft tissue. J Clin Lab Anal 1994;8:418–423PubMed

19.

Haug CE, Jenkins RL, Rohrer RJ, et al. Liver transplantation for primary hepatic cancer. Transplantation 1992;53:376–382PubMed

20.

Gaub J, Iversen J. Rat liver regeneration after 90% partial hepatectomy. Hepatology 1984;4:902–904PubMed

21.

Kato K, Matsuda M, Kusano M, et al. The immunostimulant OK-432 enhances liver regeneration after 90% hepatectomy in rats. Hepatology 1994,19:1241–1244PubMedCrossRef

22.

Iso A, Usami M, Kasahara H, et al. Bacterial translocation induces remnant liver injury after subtotal (90%) hepatectomy in rats—the effect of decontamination of gram-negative rods in digestive tract by oral polymyxin B treatment. Jpn J Dig Dis 1996;93:544–552

23.

Zhang XK, Gauthier T, Burczynski FJ, et al. Changes in liver membrane potentials after partial hepatectomy in rats. Hepatology 1996;23:549–551PubMedCrossRef

24.

Tuczek HV, Rabes H. Loss of proliferation capacity of hepatocytes following subtotal hepatectomy. Experientia 1971;27:526PubMedCrossRef

25.

Vic P, Saint-Aubert B, Astre C, et al. Complete liver regeneration in one-stage 90% hepatectomized rats treated with testosterone. Hepatology 1982;2:247–248PubMedCrossRef

26.

Habib NA. Early mortality in 100 consecutive liver resections in 96 patients with benign and malignant liver tumours. Ann R Coll Surg Engl 1995;77:107–110PubMed

27.

Fisher B, Lee SH, Fisher ER, et al. Liver regeneration following portacaval shunt. Surgery 1962;52:88–102PubMed

28.

Sato Y, Koyama S, Tsukada K, et al. Acute portal hypertension reflecting shear stress as a trigger of liver regeneration following partial hepatectomy. Surg Today 1997;27:518–526PubMedCrossRef

29.

Mito M, Ackroyd FW, Covelli VH, et al. Partial heterotopic liver homograft in dogs utilizing portal arterialization. Ann Surg 1967;165:20–32PubMedCrossRef

30.

Starzl TE, Francavilla A, Halgrimson CG, et al. The origin, hormonal nature, and action of hepatotrophic substances in portal venous blood. Surg Gynecol Obstet 1973;137:179–199PubMed

31.

Barbare JC, Poupon R, Jaillon P, et al. The influence of vasoactive agents on metabolic activity of the liver in cirrhosis: a study of the effects of posterior pituitary extract, vasopressin, and somatostatin. Hepatology 1984;4:59–62PubMedCrossRef

32.

Braillon A, Jiron MI, Valla D, et al. Effect of propranolol on hepatic blood flow in patients with cirrhosis. Clin Pharmacol Ther 1985;37:376–380PubMedCrossRef

33.

Mosimann R, Marquis C, Mosimann F, et al. Long-term follow-up after a distal splenorenal shunt procedure. A clinical and hemodynamic study. Am J Surg 1983;145:253–255PubMedCrossRef

34.

Vinel JP, Caucanas JP, Cales P, et al. Effect of propranolol on metabolic activity of the liver in patients with alcoholic cirrhosis. J Hepatol 1988;7:186–192PubMedCrossRef

Title: Effect of Portocaval Shunt on Residual Extreme Small Liver after Extended Hepatectomy in Porcine
Authors: HongSheng Wang, MD, PhD
Nobuhiro Ohkohchi, MD, PhD
Yoshitaka Enomoto, MD
Masahiro Usuda, MD
Shigehito Miyagi, MD
Hiroo Masuoka, MD
Satoshi Sekiguchi, MD
Naoki Kawagishi, MD
Keisei Fujimori, MD
Akira Sato, MD
Susumu Satomi, MD, PhD
Publication date: 01-11-2006
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 11/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-005-0294-4

2024 ASCO Annual Meeting

Springer Medicine

Effect of Portocaval Shunt on Residual Extreme Small Liver after Extended Hepatectomy in Porcine

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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