POSTOPERATIVE PANCREATITIS IN HEPATIC RESECTIONS - ROLE OF PRINGLE'S MANEUVER

Abstract

Background: The mechanism of postoperative pancreatitis still remains not profoundly explored in the area of liver resections. Three main mechanisms are named for the origin of pancreatitis following liver resections. The first mechanism has its foundation based on intrahepatic bile-ducts lithiasis, which leads to bile-stones or sludge migration during operation, obstructing the duodenal papilla The other mechanism elucidates haemobilia as the main factor, forming blood clots that migrate and obstruct the duodenal papilla. The Pringle maneuver is the third reason for pancreatitis, which causes blood congestion in the splanchnic area, particularly the pancreatic venous vessels. Aim: to evaluate and define the leading mechanism of developing postoperative pancreatitis in liver resections by statistical retrospective analysis and explore the main complications following pancreatitis. Methods: For the period from 2018 to 2023, 64 patients developed postoperative pancreatitis after liver resections. The study was conducted in a retrospective study fashion, exploring statistically the reasons and mechanisms leading to pancreatitis, comparing different factors like the type of liver resection, presence or lack of haemobilia, application of Pringle maneuver, time under warm ischemia utilizing the Pringle maneuver. Data was processed with SPSS ver 23.000 Results: Pancreatitis was found predominantly after atypical liver resections and bi-segmental resections. Haemobilia didn't prove to be a factor for pancreatitis. Warm ischemia and the time of its application proved to be one of the main factors for pancreatitis. Conclusions: Warm ischemia and type of liver resection are the main factors leading to the development of pancreatitis.