Importance of hepatovenous back-perfusion for maintenance of liver viability during the Pringle manoeuvre

Abstract

The role of hepatovenous back-perfusion in maintaining hepatic viability was investigated during inflow occlusion (Pringle manoeuvre) of the pig liver. The study compared two ischaemia procedures of 60 min duration: hepatic inflow occlusion and inflow plus outflow occlusion (vascular exclusion). Each procedure was carried out in six pigs and liver tissue perfusion, energy metabolism, lipid peroxidation and 7-day survival were assessed. Although all pigs survived after inflow occlusion, five of six died after vascular exclusion (P < 0.01). Exclusion induced a significant decrease in perfusion to 15.3 per cent of the value before ischaemia compared with 32.4 per cent after hepatic inflow occlusion alone (P < 0.01). Although cellular adenosine 5'-triphosphate levels were significantly decreased by ischaemia in both groups, the fall was less in pigs with inflow occlusion alone (to 55 per cent of the preclamp value) than in those with exclusion (to 24 per cent of the preclamp value) (P < 0.01). The plasma phosphatidylcholine hydroperoxide level rose immediately after reperfusion in pigs with exclusion, while the level remained constant after inflow occlusion alone. There is a fundamental difference between the two ischaemia procedures: back-perfusion from the vena cava contributes to the maintenance of liver function during inflow occlusion.

Difference in Hepatic Tissue Oxygenation between Total Vascular Exclusion and Inflow Occlusion of the Liver and the Possible Role of Hepatic Venous Blood under Liver Ischemia

“…The difference in damage between IO and TVE seemed to be the result of the presence of hepatic venous blood. From this point of view, our results corroborated those of a recent study by Tatsuma et al [15]. They carried out IO and TVE on swine livers for 60 min and observed a fundamental difference between them by assessing tissue blood flow, energy metabolism, lipid peroxidation, and 7-day survival.…”

Intraosseous Hypertonic Saline Solution for Resuscitation of Uncontrolled, Exsanguinating Liver Injury in Young Swine

“…The volume of bleeding from this segment occurs through the injured area of the liver [47]. When there are lesions in the hepatic veins, even after clamping of the porta hepatis, the volume of bleeding continues in the injured parenchyma from backflow through the hepatic veins [24][25][26], justifying apprehension of the use of the inferior vena cava tributaries for volume restoration in view of liver injuries.…”

“…Residual blood flow, many times important, is considered to originate from the hepatic vein backflow [24][25][26].…”

Progress in Surgical Treatment of Hepatocellular Carcinoma

“…Unnecessary blood transfusions, in fear of sudden massive hemorrhage, can lead to the vicious cycle of bleeding and transfusion. Moreover, a study in pigs has demonstrated that back-perfusion from the hepatic vein, during the inflow occlusion technique, contributes toward maintenance of hepatic function during the inflow occlusion [34]. In summary, the intermittent inflow occlusion technique is simple and easy to perform, and it contributes toward minimizing the blood loss during hepatic parenchymal dissection, without significant adverse effects on the liver function.…”