OP 114. Hepatic Hemodynamic Changes after Stepwise Liver Resection

M. Golriz, S. Elsakka, A Edalatpour, J. Arwin, N. Rezaei, R. Hafezi, C. Garoussi, A Saffari, M. Ashrafi, G. Emami, A Mehrabi

Chair(s): Thomas van Gulik, Attila Szijártó, András Fülöp

13:00 - 13:10h at Pest Room (C)

Categories: Abdominal Wall and Hernia

Session: Oral Session XIII - Hepatobiliary and Pancreatic Surgery I

Background:
Extended liver resection has increased during the last decades. However, hepatic hemodynamic changes after resection and the consequent complications like small for size syndrome are still a challenging issue. The aim of this study was to systematically evaluate the role of sequential liver resection on hepatic hemodynamic changes.

Material and Methods:
To evaluate this effect we performed 25, 50 and 75 % sequential liver resections in 8 pigs. Before and after each resection the flow of the hepatic artery (HAF) and portal vein (PVF) in relation to the 100 gram remnant liver as well as pressure of the portal vein (PVP) were measured and compared between the groups.

Result:
Following sequential liver resection, the total hepatic inflow (HAF+PVF) increases gradually. In details, the HAF decreases 17% and PVF increases 73% after extended liver resection (75%). Also, with sequential liver resection, the PVP increases gradually up to 33% after extended liver resection (75%).

Parameters

Before Resection

Resection 25%

Resection 50%

Resection 75%

Trend

HAF (ml/min/100g)

29

29

25

24

17% ↓

PVF (ml/min/100g)

102

134

150

279

173% ↑↑↑

THF (ml/min/100g)

131

163

175

303

131% ↑↑

PVP (mmHg)

12

13

15

16

33% ↑

Conclusion:
Sequential increase in the liver resection volume decreases the HAF/min/100g and increase the PVF/min/100g and PVP. This results in a THF with poorer O2 blood supply and higher pressure. This phenomenon can explain the mechanism of the postoperative complications of small for size syndrome, which lead to liver failure.

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