Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits

Abstract

Background:The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle’s maneuver), continuous prolonged clamping results in liver ischemia.Objectives:The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models.Materials and Methods:In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers.Results:There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation.Conclusions:Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.

Massage of the Hepatoduodenal Ligament Recovers Portal Vein Flow Immediately After the Pringle Maneuver in Hepatectomy

“…In a previous study, the appropriate clamping time and declamping time for the Pringle maneuver were reported [29]. Another report concluded that 30 min is an appropriate clamping time to protect against ischemic injury and suggested a reperfusion time of 5 min [30].…”

The Impact of Cross-Clamping of The Portal Triad on The Morphology of The Small Intestine

“…The duration of continuous clamping can be up to 90 minutes in the absence of liver pathology or up to 50 minutes in the presence of liver disease (13). Kolahdoozan et al demonstrated in experiments on animals that the safe time interval for clamping the PT was 30-45 minutes (average) (14).…”