A Prospective, Randomized, Controlled Trial Comparing Intermittent Portal Triad Clamping Versus Ischemic Preconditioning With Continuous Clamping for Major Liver Resection

Petrowsky, Henrik; McCormack, Lucas; Trujillo, Martha; Selzner, Markus; Jochum, Wolfram; Clavien, Pierre Alain

doi:10.1097/01.sla.0000246834.07130.5d

Cited by 191 publications

(187 citation statements)

References 36 publications

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“…[10][11][12][13][14][15] In laboratory animals and humans, IPC of the liver may be induced either by a single short period of ischemia or multiple short cycles of ischemia (or intermittent hilar clamping). 16 In a rat liver transplant model, Yin et al 2 investigated single IPC periods ranging between 5 and 20 minutes and showed that 10 minutes induced the best protection. Although 10 to 15 minutes of RP after the preconditioning ischemia has become a methodological tradition following the initial laboratory work, more recent work by Glanemann et al, 17 in rat liver warm ischemia, showed that 30 to 45 minutes of RP were more effective than 5 to 15 minutes.…”

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confidence: 99%

Ischemic preconditioning of the liver: A few perspectives from the bench to bedside translation

et al. 2008

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Utilization of ischemic preconditioning to ameliorate ischemia/reperfusion injury has been extensively studied in various organs and species for the past two decades. While hepatic ischemic preconditioning in animals has been largely beneficial, translational efforts in the two clinical contexts-liver resection and decreased donor liver transplantation-have yielded mixed results. This review is intended to critically examine the translational data and identify some potential reasons for the disparate clinical results, and highlight some issues for further studies.

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confidence: 99%

Ischemic preconditioning of the liver: A few perspectives from the bench to bedside translation

et al. 2008

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“…Accordingly, the intermittent clamping of the hepatic pedicle proved to be more effective in attenuating ischemia-reperfusion injury compared to the continuous portal triad clamping 7 . In this context, the interest in hyperbaric oxygen therapy (HBO) has grown due to its role in ischemia and reperfusion injury therefore in the liver transplantation field 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Effect of hyperbaric oxygen therapy on liver function during intermittent ischemia

Baldim

Nejo

Souza³

et al. 2013

Acta Cir. Bras.

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PURPOSE:To analyze the effects of hyperbaric oxygen therapy on liver function in rats previously subjected to ischemia and reperfusion. METHODS: A randomly distribution of 23 Wistar rats was conducted into three groups: SHAM, animals subjected to surgical stress without restricting blood flow by clamping the hepatic pedicle, IR, rats underwent hepatic vascular occlusion intermittently for two complete cycles of 15 minutes of ischemia followed by 5 min of reperfusion, IR / HBO, rats underwent hepatic pedicle clamping and thereafter exposed to hyperbaric oxygen pressure of 2 absolute atmospheres for 60 minutes. We evaluated liver function through mitochondrial function, determined by the stages 3 and 4 of respiration, respiratory control ratio (RCR) and mitochondrial permeability transition (Swelling). Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also quantified . We analyzed the results using the Mann-Whitney test and were considered significant all results with p <0.05. RESULTS: There were significant differences between the results of stage 3 in SHAM vs IR group ; of the stage 4 in the groups IR vs SHAM and SHAM vs IR /HBO; of the Respiratory Control Ratio (RCR) in the group IR vs IR / HBO ; of alanine aminotransferase in the groups IR vs SHAM , SHAM vs IR/HBO and IR vs IR / HBO; aspartate aminotransferase in the groups SHAM vs IR and SHAM vs IR / HBO. CONCLUSION: The whole analysis of the mitochondiral function indicators permits us to conclude that the hyperbaric oxygen therapy acted as a protective agent of the mitochondrial function, minimizing the ischemia-reperfusion injury of the hepatic parenchyma. Key words: Hyperbaric Oxygen Therapy. Mitochondria. Liver Ischemia. Reperfusion. RESUMO OBJETIVO:Analisar os efeitos da oxigenoterapia hiperbárica sobre a função hepática de ratos previamente submetidos à isquemia e reperfusão. MÉTODOS: Realizou-se a distribuição aleatória de 23 ratos Wistar em três grupos: SHAM, animais submetidos ao estresse cirúrgico sem restrição de fluxo sanguíneo por clampeamento do pedículo hepático; IR ratos submetidos a oclusão vascular hepática de maneira intermitente em dois ciclos completos de 15 minutos de isquemia, seguidos por 5 min de reperfusão; IR/HBO, ratos submetidos ao clampeamento do pedículo hepático e ,ulteriormente , expostos a oxigenoterapia hiperbárica a pressão de 2 atmosferas absolutas durante 60 minutos. Avaliou-se a função hepática através da função mitocondrial, determinada pelos estados 3 e 4 da respiração mitocondrial, razão de controle respiratório(RCR) e transição de permeabilidade mitocondrial (Swelling) .Quantificou-se também alanina aminotransferase e aspartato aminotransferase séricas. Analisou-se os resultados pelo teste de Mann-Whitney e foram considerados significativos os valores de p < 0,05. RESULTADOS:Houve diferença significativa nos valores do estado 3 no grupo SHAM vs IR; estado 4 nos grupos SHAM vs IR, SHAM vsIR/HBO; Razão de Controle Respiratório(RCR) no grupo IR vs IR/HBO; alanina aminotransferase n...

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“…There is not a consensus approach of which method is the best for clamping the hepatic pedicle and many authors present different results 4,21,23 . The Cochrane Institute for Systematic Reviews published a paper in 2007 showing the evidence that intermittent clamping is safe but it does not decrease the morbidity of the procedure without any clinical evidence appearing until that date 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Was observed that these animals tolerate ischemia for 60 minutes with low mortality and submitting them to intermittent ischemia produces no mortality 18 . Different models of intermittent ischemia have been described and was chosen one of them in this study, considering that after 10 to 12 minutes of ischemia, three to five minutes of reperfusion are sufficient to restore the intra-hepatic tissue oxygenation 6,23,28 . In this study, the difference between total ischemic time of the ischemia in the continuous and intermittent groups (60 versus 48 minutes) occurred to mimic the real clinical situations experienced during the surgical procedures 4 .…”

Section: Discussionmentioning

confidence: 99%

Lesão de isquemia e reperfusão após clampagem contínua ou intermitente do pedículo hepático em coelhos

Seabra

Savassi-Rocha

Vasconcelos

et al. 2012

ABCD, arq. bras. cir. dig.

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-Background -The control of bleeding in hepatectomy is a challenge for surgeons. The hepatic pedicle clamping is a surgical maneuver that can provide reduction in bleeding, but it provokes a hepatocellular suffering. This, along with reperfusion after the clamping finishes, leads to an injury known as ischemia/reperfusion injury. Aim -To examine the effects of the ischemia/reperfusion injury on the liver after continuous and intermittent hepatic pedicle clamping in an animal model, using the quantification of apoptosis for evaluation. Method -Twenty New Zealand rabbits were assigned to groups 1 (control), 2 (60 minutes of continuous ischemia) and 3 (60 minutes of intermittent ischemia alternating 12 minutes of ischemia and three minutes of reperfusion). Liver biopsies were collected before ischemia, at its end and after six hours of reperfusion, when the animals were killed. The liver fragments were subjected to histological analysis (paraffinization and hematoxilin-eosin staining) and histochemical (Tunel reaction). Microscope fields of view were scanned for characterization and quantification of apoptosis. Results -Ischemia led to an increased apoptotic index in both experimental groups in comparison to controls, but similarly between them. After the reperfusion, the indexes returned to baseline values. Conclusion -Clamping of the hepatic pedicle, either continuous or intermittent, induces apoptosis in liver cells in a similar way. ABCDDV/852RESUMO -Racional -O controle do sangramento na hepatectomia é um desafio para os cirurgiões. A clampagem do pedículo hepático é manobra cirúrgica que pode promover redução do sangramento, mas provoca isquemia hepatocelular. Isso, junto com a reperfusão depois que a clampagem termina, leva à lesão de isquemia e reperfusão. Objetivo -Examinar os efeitos da lesão de isquemia e reperfusão no fígado após clampagem contínua e intermitente do pedículo hepático, usando a quantificação de apoptose como ferramenta. Método -Vinte coelhos New Zealand foram divididos em grupos 1 (controle), 2 (60 minutos de isquemia contínua) e 3 (60 minutos de isquemia intermitente alternando 12 minutos de isquemia e três minutos de reperfusão). Biópsias hepáticas foram colhidas antes e ao fim da isquemia e após seis horas de reperfusão, quando os animais eram sacrificados. Os fragmentos obtidos foram submetidos à análise histológica e histoquímica (reação de Tunel). Campos microscópicos foram analisados para caracterização e quantificação de apoptose. Resultados -A isquemia levou à elevação do índice apoptótico em ambos os grupos experimentais em relação aos controles, mas similar entre eles. Depois da reperfusão os índices voltaram aos valores iniciais. Conclusão -A clampagem do pedículo hepático, tanto contínua quanto intermitente, induz a apoptose em células hepáticas de modo igual.

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A Prospective, Randomized, Controlled Trial Comparing Intermittent Portal Triad Clamping Versus Ischemic Preconditioning With Continuous Clamping for Major Liver Resection

Cited by 191 publications

References 36 publications

Ischemic preconditioning of the liver: A few perspectives from the bench to bedside translation

Ischemic preconditioning of the liver: A few perspectives from the bench to bedside translation

Effect of hyperbaric oxygen therapy on liver function during intermittent ischemia

Lesão de isquemia e reperfusão após clampagem contínua ou intermitente do pedículo hepático em coelhos

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