Abstract
ABSTRACT Background: Hepatectomies promote considerable amount of blood loss and the need to administrate blood products, which are directly linked to higher morbimortality rates. The blood-conserving hepatectomy (BCH) is a modification of the selective vascular occlusion technique. It could be a surgical maneuver in order to avoid or to reduce the blood products utilization in the perioperative period. Aim: To evaluate in rats the BCH effects on the hematocrit (HT) variation, hemoglobin serum concentration (HB), and on liver regeneration. Methods: Twelve Wistar rats were divided into two groups: control (n=6) and intervention (n=6). The ones in the control group had their livers partially removed according to the Higgins and Anderson technique, while the rats in the treatment group were submitted to BCH technique. HT and HB levels were measured at day D0, D1 and D7. The rate between the liver and rat weights was calculated in D0 and D7. Liver regeneration was quantitatively and qualitatively evaluated. Results: The HT and HB levels were lower in the control group as of D1 onwards, reaching an 18% gap at D7 (p=0.01 and p=0.008, respectively); BCH resulted in the preservation of HT and HB levels to the intervention group rats. BCH did not alter liver regeneration in rats. Conclusion: The BCH led to beneficial effects over the postoperative HT and serum HB levels with no setbacks to liver regeneration. These data are the necessary proof of evidence for translational research into the surgical practice. : A) Unresected liver; B) liver appearance after the partial hepatectomy (1=vena cava; 2=portal vein; 3=hepatic vein; 4=biliary drainage; 5=hepatic artery)
Highlights
The classic model of liver regeneration research was described by Higgins and Anderson in 1931, whom performed a 2/3 partial hepatectomy on rats and observed that in seven to ten days after the procedure the liver reassumes its original weight, reestablishing the normal liver weight/body weight rate, which results in 3.58% in rats[17]
All the rats survived to the partial hepatectomy (D0) and to the caudate lobe biopsy procedure (D1)
The partial hepatectomy intraoperative time in the control group was 51.2 min (±8.6) while in the intervention group it resulted in 65.5 min (±11.3)
Summary
The liver is a complex organ. An actual chemical laboratory, it is responsible for more than 5000 functions in the body[6]. The rational use of blood products and the management of intraoperative hemorrhage are major concerns in the surgical practice of liver operations. This fact relies on researches that found strict correlation between higher morbimortality rates and the amount of blood loss and blood units transfused[9,12,19]. Afterwards a partial hepatectomy or liver transplantation (split-liver graft or living donor graft), the hepatic regeneration takes place. This extremely complex phenomenon reestablishes the liver weight/body weight rate. We intended to evaluate the consequences of this vascular occlusion technique on liver regeneration
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