Pedicle clamping with ischemic preconditioning in liver resection

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Transplantation

Background:

• Hepatic pedicle clamping (HPC) controls bleeding during hepatectomy.
• Intermittent HPC is better tolerated but causes reperfusion bleeding.
• Ischemic preconditioning (IP) reduces ischemia-reperfusion damage for up to 30 minutes of continuous clamping in healthy liver.

Purpose of the Study:

• To evaluate the safety and efficacy of IP for prolonged continuous clamping during hepatectomy in patients with healthy livers.
• To compare liver damage markers and blood loss between patients undergoing IP and those receiving continuous clamping alone.

Main Methods:

• A prospective study involving 42 consecutive patients undergoing hepatectomy for healthy livers.
• Group A (21 patients) received IP before prolonged continuous clamping.
• Group B (21 patients) received continuous clamping alone.

Main Results:

• Liver ischemia averaged 54 minutes in Group A versus 36 minutes in Group B (P=.001).
• Despite longer ischemia, Group A showed lower postoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels.
• Multiple regression confirmed smaller transaminase increases with IP, irrespective of ischemia or operation duration.

Conclusions:

• Ischemic preconditioning is safe and effective for liver resection in healthy livers, even with prolonged ischemia.
• IP is better tolerated than continuous clamping alone and should be preferred in healthy liver resections.
• Further research is needed for IP in cirrhotic livers and comparison with intermittent clamping.