Longer Ischemic Intervals During Liver Surgery Do No Harm

Doubling intermittent ischemic periods to occlude hepatic blood flow for 30 minutes during surgery do not worsen hepatocellular injury, according to a new study.

Researchers at Maastricht University (The Netherlandsl) conducted a randomized trial to compare hepatocellular injury--reflected by liver fatty acid-binding protein (L-FABP)--in 20 patients undergoing liver resection with intermittent Pringle maneuver (IPM), using 15 or 30 minutes ischemic intervals. The patients were randomly assigned to IPM with 15 or 30 minutes of ischemic intervals; 10 patients not requiring IPM served as controls. The primary endpoint was hepatocellular injury during liver surgery, reflected by systemic L-FABP plasma levels.

The results showed that the IPM groups had similar characteristics. Aminotransferases did not differ significantly between the 15-minute and the 30-minute groups at any time point. L-FABP levels rose up to 1853 ± 708 ng/mL in the 15-minute group and 3662 ± 1355 ng/mL in the 30-minute group after finishing liver transaction, and decreased rapidly thereafter. There were no significant differences between groups in cumulative L-FABP level, or L-FABP level at any time point. Blood loss, remnant liver function, and morbidity were comparable. Cumulative ischemia times were statistically similar in the two study groups, at an average of 34 minutes in the 15-minute group and 51 minutes in the 30-minute group. The study was published in early online on December 10, 2010, in the Journal of Hepatology.

"The current study was novel because instead of using alanine and aspartate aminotransferases to assess remnant function, it used a more sensitive marker of liver damage called liver fatty acid-binding protein,” said Cornelis Dejong, MD, and colleagues of the departments of surgery and nutrition and toxicology research. "The present study confirms the results of earlier trials, suggesting that IPM with 30 minutes ischemic intervals may be used.”

The Pringle maneuver is used in some abdominal operations. A large hemostat is used to clamp the hepatoduodenal ligament interrupting the flow of blood through the hepatic artery and the portal vein, and thus helping to control bleeding from the liver.

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