OP 115. Hepatic Inflow Modulation after Extended Liver Resection via Shunt Surgery

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

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

13:10 - 13:20h at Pest Room (C)

Categories: Abdominal Wall and Hernia

Session: Oral Session XIII - Hepatobiliary and Pancreatic Surgery I

Background:
One of the most challenging issues after extended liver resection is decrease of the hepatic artery flow and increase of the portal vein flow and pressure in the remnant liver with the risk of small for size syndrome (SFSS). The aim of this study was to evaluate the role of shunt surgery in hepatic inflow modulation after extended liver resection.

Material and Methods:
24 pigs were divided into three groups: Group A: 75% liver resection without shunt (n=8); Group B) 75% liver resection with side to side portocaval shunt (PCS S-S); Group C: 75% liver resection with end to side portocaval shunt (PCS E-S). The flow of the hepatic artery (HAF) and portal vein (PVF) in relation to the 100 gram remnant liver as well as the pressure of the portal vein (PVP) were measured and compared between the groups.

Result:
In Group A, extended liver resection (75%) decreased the HAF (20%) and increased the PVF (119%) and PVP (68%). In Group B, the PCS S-S following extended liver resection (75%) could increase the HAF (12%) and decrease the PVF (78%) and PVP (48%) in comparison to Group A. In Group C, the PCS E-S following extended liver resection (75%) could increase the HAF (44%) and decrease the PVP (38%) in comparison to Group A.

Parameters

Baseline

Group A
75% Resection

Group B
75% Resection + PCS S-S

Group C

75% Resection + PCS E- S

HAF (ml/min/100g)

30

24

27

34

PVF (ml/min/100g)

127

279

60

  

PVP (mmHg)

9.5

16

8.3

9.9

Conclusion:
Portocaval shunt can increase the dropped HAF and reduce the increased PVF and PVP, after extended liver resection. In increasing the HAF after extended liver resection, the PCS E-S seems to be more effective than PCS S-S. In case of the risk of SFSS, the hepatic inflow modulation after extended liver resection through portocaval shunt might prevent the consequent postoperative complications. 

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