Adhesions as a risk factor for postoperative morbidity in patients undergoing repeat hepatectomy and the potential efficacy of adhesion barriers

Okubo, Satoshi; Shindoh, Junichi; Matsumura, Masaru; Hashimoto, Masaji

doi:10.1002/jhbp.1047

Cited by 11 publications

(13 citation statements)

References 19 publications

(41 reference statements)

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“…Overnutrition aggravates a variety of unfavourable outcomes, including increased adiposity [26], lipotoxicity [27], chronic inflammation [28] and oxidative stress [29], which accelerate hepatocyte dysfunction in the development of NAFLD, a prominent feature of metabolic disorders [30]. To maintain energy metabolism in the hepatic microenvironment in order to inhibit NAFLD is highly demanding.…”

Section: Discussionmentioning

confidence: 99%

Chaperonin counteracts diet-induced non-alcoholic fatty liver disease by aiding sirtuin 3 in the control of fatty acid oxidation

Weng

Shen

et al. 2023

Diabetologia

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Aims/hypothesis The mitochondrial chaperonin heat shock protein (HSP) 60 is indispensable in protein folding and the mitochondrial stress response; however, its role in nutrient metabolism remains uncertain. This study investigated the role of HSP60 in diet-induced non-alcoholic fatty liver disease (NAFLD). Methods We studied human biopsies from individuals with NAFLD, murine high-fat-diet (HFD; a diet with 60% energy from fat)-induced obesity (DIO), transgenic (Tg) mice overexpressing Hsp60 (Hsp60-Tg), and human HepG2 cells transfected with HSP60 cDNA or with HSP60 siRNA. Histomorphometry was used to assess hepatic steatosis, biochemistry kits were used to measure insulin resistance and glucose tolerance, and an automated home cage phenotyping system was used to assess energy expenditure. Body fat was assessed using MRI. Macrophage infiltration, the lipid oxidation marker 4-hydroxy-2-nonenal (4-HNE) and the oxidative damage marker 8-hydroxy-2′-deoxyguanosine (8-OHdG) were detected using immunohistochemistry. Intracellular lipid droplets were evaluated by Nile red staining. Expression of HSP60, and markers of lipogenesis and fatty acid oxidation were quantified using RT-PCR and immunoblotting. Investigations were analysed using the twoway ANOVA test. Results Decreased HSP60 expression correlated with severe steatosis in human NAFLD biopsies and murine DIO. Hsp60-Tg mice developed less body fat, had reduced serum triglyceride levels, lower levels of insulin resistance and higher serum adiponectin levels than wild-type mice upon HFD feeding. Respiratory quotient profile indicated that fat in Hsp60-Tg mice Shao-Wen Weng and Jian-Ching Wu contributed equally to this study.

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Section: Discussionmentioning

confidence: 99%

Chaperonin counteracts diet-induced non-alcoholic fatty liver disease by aiding sirtuin 3 in the control of fatty acid oxidation

Weng

Shen

et al. 2023

Diabetologia

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“…The degree of adhesions present during RH has been reported to be related to the di culty of the surgery and to correlate with postoperative complications. [19,20] Some reports comparing LRH with ORH have shown the bene t of LRH. [12,13,21] In particular, LRH has been reported to reduce blood loss, with the same incidence of postoperative complications and a shorter postoperative hospital stay compared to those of ORH.…”

Section: Discussionmentioning

confidence: 99%

Appropriate indications for laparoscopic repeat hepatectomy

Masuda

Endo

Amano

et al. 2023

Preprint

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Background: Laparoscopic repeat hepatectomy (LRH) has increased, but appropriate indications for LRH are unclear. This study aimed to clarify appropriate indications for LRH. Methods: We retrospectively compared surgical outcomes between open RH (ORH) (n=57) and LRH (n=40) groups. To detect difficult cases of complete pure LRH, we examined patients with unplanned intraoperative hand-assisted laparoscopic surgery (HALS)/open conversion (n=6). Results: In the LRH versus ORH group, as previous hepatectomy, laparoscopic (75% vs. 12%, p<0.001) and Hr0 (73% vs. 37%, p=0.002) were more frequently performed, and as RH procedure, Hr0 (88% vs. 47%, p=0.0002)was more frequently performed. S1 tumor cases were higher in ORH group (11% vs. 0%), but S2-6 cases were higher in LRH group(73% vs. 49%) (p=0.02). In LRH group, compared to the pure LRH patients, HALS/open conversion patients underwent significantly more previous hepatectomy with Hr2-3 (33% vs. 2.9%, p=0.033) and more RH procedures with HrS (33% vs. 2.9%, p=0.03). All LRH requiring a second hepatic hilar approach were HALS conversions. Conclusion: Appropriate indications for LRH were previous hepatectomy was laparoscopic Hr0, and RH procedure was Hr0 for S2-6 tumor location. When RH is more than HrS requiring a second hepatic hilar approach, LRH should not be selected due to the high possibility of HALS/open conversion.

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“…One reason for the paucity of data is that most of the studies have evaluated sheet-type adhesion-preventative barrier, which are manufactured mainly to prevent flat adhesions, such as those that occur between the intestinal tract and abdominal wall. Although sheet-type adhesion-preventative barriers are not suitable for the resection of the liver, which has a complex three-dimensional structure, their utility in liver resection has been reported to some extent [ 15 ]. However, handling of sheet-type adhesion-preventative barriers, particularly in MIHs with small wounds, is complicated as the sheets may stick or break during the process, which may impair some of their intended functions.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, for liver resection with three-dimensional structures, spray-type adhesion-preventative barrier should be useful, specifically in MIH where manipulative behavior is restricted. Among the currently available adhesion-preventative barrier the efficacy and safety of AdSpray™ (Terumo Corporation, Tokyo, Japan), which has gel-like properties based on NHS-enriched CM dextrin [ 16 ], have been reported in patients undergoing liver resection [ 15 , 16 , 17 ]. A study using a preclinical liver resection model was the first to demonstrate that the use of AdSpray™ contributed to a reduction in adhesions [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, one study reported that the system, spraying solution which turns into gel in 10 sec., prevented adhesions to the porta hepatis, a crucial component during the resection of complex three-dimensional structures, and improved surgical manipulation [ 17 ]. Conversely, another study reported that due to its solution state, AdSpray™ might flow into the dissected liver surface after surgery, thereby inhibiting the adhesion necessary for healing, resulting in increased incidences of intra-abdominal abscesses [ 15 ]. Thus, data on the safety of AdSpray™ in MIH are limited.…”

Section: Introductionmentioning

confidence: 99%

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The First Prospective Study Investigating the Safety and Feasibility of a Spray-Type Adhesion Barrier (AdSpray™) in Minimally Invasive Hepatectomy: An Analysis of 124 Cases at Our Institution

Kojima,

Sugioka,

Kato

2024

JPM

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(1) Background: With the increasing demand for repeat hepatectomy, preventing perihepatic adhesion formation following initial hepatectomy is crucial. Adhesion-preventative barriers, like the new spray-type AdSprayTM (Terumo Corporation, Tokyo, Japan), have been proposed to reduce adhesion risk. However, data on their safety in minimally invasive hepatectomy (MIH) remain scarce. This is the first prospective study to evaluate the safety and feasibility of AdSprayTM in MIH. (2) Methods: A total of 124 patients who underwent MIH with AdSprayTM and 20 controls were analyzed. Subgroup analysis according to the AdSpray™ application area was conducted. Major complications were assessed using the Clavien–Dindo classification. Moreover, intraperitoneal pressure during AdSpray™ application was monitored in 20 cases. (3) Results: Major complications occurred in 6.4% of the patients, which was comparable to that in open hepatectomy. Intraperitoneal pressure remained stable below 12 mmHg during AdSpray™ application without any complications. No significant difference in complication rates was observed among subgroups. However, a potential increase in intra-abdominal abscess formation was suspected with AdSpray™ application to the resected liver surfaces. (4) Conclusions: AdSpray™ can be safely used in MIH; however, further research is needed to confirm the appropriacy of using AdSpray™, particularly over resected liver surfaces. Overall, AdSpray™ is a promising tool for enhancing the safety of MIH.

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Adhesions as a risk factor for postoperative morbidity in patients undergoing repeat hepatectomy and the potential efficacy of adhesion barriers

Cited by 11 publications

References 19 publications

Chaperonin counteracts diet-induced non-alcoholic fatty liver disease by aiding sirtuin 3 in the control of fatty acid oxidation

Chaperonin counteracts diet-induced non-alcoholic fatty liver disease by aiding sirtuin 3 in the control of fatty acid oxidation

Appropriate indications for laparoscopic repeat hepatectomy

The First Prospective Study Investigating the Safety and Feasibility of a Spray-Type Adhesion Barrier (AdSpray™) in Minimally Invasive Hepatectomy: An Analysis of 124 Cases at Our Institution

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