Portocaval shunt can optimize transhepatic flow following extended hepatectomy: a short-term study in a porcine model

Mohammad Golriz,Jalal Arwin,Nahid Rezaei,Golnaz Emami,Arianeb Mehrabi,Sepehr Abbasi,Ali Majlesara,Arash Saffari,Mohammadreza Hafezi,Saroa El Sakka,Elias Khajeh,Ali Ramouz

doi:10.1038/s41598-022-05327-3

Abstract

The aim of this study was to evaluate whether the portocaval shunt (PCS) corrects these unwanted changes in transhepatic flow after extended hepatectomy (EH). Forty female Landrace pigs were divided into two main groups: (A) EH (75%) and (B) no EH. Group A was divided into 3 subgroups: (A1) EH without PCS; (A2) EH with side-to-side PCS; and (A3) EH with end-to-side PCS. Group B was divided into 2 subgroups: (B1) side-to-side PCS and (B2) end-to-side PCS. HAF, PVF, and PVP were measured in each animal before and after the surgical procedure. EH increased the PVF/100 g (173%, p < 0.001) and PVP (68%, p < 0.001) but reduced the HAF/100 g (22%, p = 0.819). Following EH, side-to-side PCS reduced the increased PVF (78%, p < 0.001) and PVP (38%, p = 0.001). Without EH, side-to-side PCS reduced the PVF/100 g (68%, p < 0.001) and PVP (12%, p = 0.237). PVP was reduced by end-to-side PCS following EH by 48% (p < 0.001) and without EH by 21% (p = 0.075). PCS can decrease and correct the elevated PVP and PVF/100 g after EH to close to the normal values prior to resection. The decreased HAF/100 g in the remnant liver following EH is increased and corrected through PCS.

Highlights

Abbreviations extended hepatectomy (EH) Extended hepatectomy hepatic artery flow (HAF) Hepatic artery flow PVF Portal vein flow portal vein pressure (PVP) Portal vein pressure small for size and flow (SFSF) Small for size and flow portocaval shunt (PCS) Portocaval shunt
Current viewpoints strongly indicate that the incidence of SFSF after EH is directly dependent on transhepatic flow and remnant liver volume[8,9,10,11]
The aim of this study was to determine whether a portocaval shunt (PCS) can correct the unwanted changes that occur in transhepatic flow following EH

Summary

Introduction

Abbreviations EH Extended hepatectomy HAF Hepatic artery flow PVF Portal vein flow PVP Portal vein pressure SFSF Small for size and flow PCS Portocaval shunt. Current viewpoints strongly indicate that the incidence of SFSF after EH is directly dependent on transhepatic flow and remnant liver volume[8,9,10,11]. Portal vein flow (PVF), hepatic artery flow (HAF), and portal vein pressure (PVP) have been described as the main critical parameters for the development of SFSF12,13. Following EH, the ratio of HAF to the remnant liver weight (HAF/100 g) decreases, while PVF/100 g and PVP increase, resulting in various pathologic consequences that lead to SFSF10,14–16. Vascular modulation, which is able to decrease PVF/100 g and PVP, as well as increase HAF/100 g following EH, may prevent the occurrence of S FSF18–21. The aim of this study was to determine whether a portocaval shunt (PCS) can correct the unwanted changes that occur in transhepatic flow following EH

Objectives

Methods

Results

Conclusion