Ischemia/reperfusion injury in liver resection: A review of preconditioning methods

Abstract

Ischemic preconditioning is one of the therapeutic interventions aiming at preventing ischemia/reperfusion-related injury. Numerous experimental studies and a few clinical series have shown that during liver resections, ischemic preconditioning is a promising strategy for optimizing the postoperative outcome. Moreover, various types of pharmacological intervention as well as different types of preconditioning, such as remote preconditioning, the use of heat shock, and hyperbaric oxygen, have been developed to attenuate the functional impairment accompanying ischemia/reperfusion injury. This review summarizes the various forms of preconditioning, thus suggesting that close cooperation between surgeons and anesthesiologists paves the way to apply novel strategies to improve the outcome of liver resection.

Effects of hyperbaric oxygen therapy on the liver after injury caused by the hepatic ischemia-reperfusion process

“…Ischemia is related to the triggering of a series of biochemical reactions that ultimately injure the hepatic tissue, while reperfusion is related to the generation of free radicals, among other factors [5][6][7] .…”

“…The I/R process involves changes ranging from microvascular alterations to the activation of neutrophils, platelets, Kupffer cells and sinusoidal endothelial cells [7][8][9] . Thus, the objective of the present study was to investigate the effect of the use of HBO after an I/R process.…”

A prospective randomized controlled trial: Comparison of two different methods of hepatectomy

“…To a varying extent, these techniques interfere with the hemodynamic status of the patient, and induce ischemia-reperfusion injury to the remnant liver. 27 The harmonic scalpel, with its simultaneous hemostatic and coagulating effect, has been used in open and endoscopic liver surgery. The main benefit of this device is its ability to achieve local hemostasis of vessels of up to 4 mm, with minimal injury to surrounding tissues.…”

Hyperoxic preconditioning in partial liver ischemia

“…The ischemic preconditioning has been proved to improve the tissue response to ischemia during procedures such as mentioned before, because of the induced adaptation of the liver to the ischemic environment 1,2 . These facts helped develop some very important techniques in liver surgery, such as the Pringle Technique 3,4 .…”