Vascular Occlusion Techniques during Liver Resection

Gulik, Thomas M. van; Graaf, Wilmar de; Dinant, Sander; Busch, Olivier R.; Gouma, Dirk J.

doi:10.1159/000103658

Cited by 87 publications

(76 citation statements)

References 114 publications

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“…Hepatic ischemia and reperfusion injury is observed following major liver surgery, transplantation, trauma and sepsis and may cause metabolic and structural hepatic damage [25,26] . This remains a significant problem in surgical procedures, and is a limitation of liver transplantation [27] .…”

Section: Discussionmentioning

confidence: 99%

Resveratrol attenuates oxidative stress and histological alterations induced by liver ischemia/reperfusion in rats

Gedik¹,

Gırgın²,

Öztürk³

et al. 2008

WJG

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AIM:To investigate the effects of resveratrol on liver ischemia/reperfusion (I/R) injury in rats. METHODS: A total of 40 male Sprague-Dawley rats weighing 240-290 g were randomized into four groups of ten: (1) controls: data from unmanipulated animals; (2) sham group: rats subjected to the surgical procedure, except for liver I/R, and given saline; (3) I/R group: rats underwent liver ischemia for 45 min followed by reperfusion for 45 min; (4) I-R/Resveratrol group: rats pretreated with resveratrol (10 µmol/L, iv). Liver tissues were obtained to determine antioxidant enzyme levels and for biochemical and histological evaluation. RESULTS: Plasma aminotransferase activities were higher in the I/R group than in the I-R/Resveratrol group. Malondialdehyde levels and the hepatic injury score decreased, while superoxide dismutase, catalase, and glutathione peroxidase levels increased in group 4 compared to group 3. In group 4, histopathological changes were significantly attenuated in resveratroltreated livers. CONCLUSION: These results suggest that resveratrol has protective effects against hepatic I/R injury, and is a potential therapeutic drug for ischemia reperfusionrelated liver injury.

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Section: Discussionmentioning

confidence: 99%

Resveratrol attenuates oxidative stress and histological alterations induced by liver ischemia/reperfusion in rats

Gedik¹,

Gırgın²,

Öztürk³

et al. 2008

WJG

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“…THVE has the advantage of less blood loss during the operation, while enabling difficult vascular reconstructions or reimplantations. It does have several adverse effects such as hemodynamic intolerance, increased operative time, and longer postoperative hospital stay compared to the PM (43,44). Nevertheless, the combination of in situ Hypothermic Perfusion (HP) of the remnant liver with the THVE is promising.…”

Section: Surgical Methods Used To Reduce Hepatic Irimentioning

confidence: 99%

Hepatic Ischemia and Reperfusion Injury and Trauma: Current Concepts

Papadopoulos¹,

Siempis²,

Theodorakou³

et al. 2013

Arch Trauma Res

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Context: Ischemia-reperfusion injury is a fascinating topic which has drawn a lot of interest in the last several years. Hepatic ischemia reperfusion injury may occur in a variety of clinical situations. These include transplantation, liver resection, trauma, and vascular surgery. Evidence Acquisition: The purpose of this review was to outline the molecular mechanisms underlying hepatic I/R injury and present the latest approaches, both surgical and pharmacological, regarding the prevention of it. A comprehensive electronic literature search in MEDLINE/PubMed was performed to identify relative articles published within the last 2 years. Results: The basic mechanism of hepatic ischemia -reperfusion injury is one of blood deprivation during ischemia, followed by the return of flow during reperfusion. It involves a complex series of events, such as mitochondrial deenergization, adenosine-5'-triphosphate depletion, alterations of electrolyte homeostasis, as well as Kupffer cell activation, oxidative stress changes and upregulation of proinflammatory cytokine signaling. The great number of variable pathways, with several mediators interacting with each other, leads to a high number of candidates for potential therapeutic intervention. As far as surgical approaches are concerned, the modification of existing clamping techniques and the ischemic preconditioning are the most promising techniques till recently. In the search for novel techniques of protecting against hepatic ischemia reperfusion injury, many different strategies have been used in experimental models. The biggest part of this research lies around antioxidant therapy, but other potential solutions have been explored as well. Conclusions:The management of hepatic trauma, in spite of the fact that it has become increasingly nonoperative, there still remains the possibility of hepatic resection in the hepatic trauma setting, especially in severe injuries. Hence, clinicians should be familiar with the concept of hepatic ischemia-reperfusion injury and respond appropriately and timely.Keywords: Reperfusion Injury; Ischemia; Pathophysiology; Prevention Implication for health policy/practice/research/medical education: Hepatic ischemia and reperfusion injury is a complex phenomenon which is commonplace in clinical practice such as the operative management of hepatic trauma, liver transplantation and liver resection. Hence, surgeons should be familiar with it and apply the necessary methods to prevent it.

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“…Selective vascular occlusion techniques have an important role in controlling blood loss in this stage of the operation, as was recently discussed elsewhere. [17][18][19][20] Van der Belt and colleagues 20 studied the application of vascular occlusion methods by sending a questionnaire to 621 surgeons in Europe. Although the overall response rate was low (50%), this study provided good insight into current practice.…”

Section: Surgical Strategies To Reduce Blood Lossmentioning

confidence: 99%