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Bacterial translocation after major hepatectomy in patients and rats
X Wang1, R Andersson, V Soltesz
1Department of Surgery, Lund University, Sweden.
Abstract:
Bacterial infections are frequent complications after liver resection. Of 138 patients who underwent major hepatectomy, 11 patients (8%) developed intra-abdominal sepsis in the postoperative period. Seven bacterial strains of gut origin were isolated from the abdominal cavity. Eight patients had multiple bacteria cultured. In the experimental studies on rat models, positive mesenteric lymph node cultures were seen 2 hours after removal of 70% and 90% of the total weight of the rat liver, and 12 hours after 50% hepatectomy, persisting for 3 and 4 days after 50% and 70% hepatectomy, respectively. The incidences of bacteremia 2 and 4 hours after 90% hepatectomy were 80% and 100%, respectively; 6 hours after 70% liver resection, the incidence of bacteremia was 33%. Blood cultures were positive in only 6% of the rats following 50% hepatectomy, and in none of the controls. Thus, bacterial translocation occurs in the early course after hepatectomy, the incidence being proportional to the amount of liver tissue removed.
Insights
Bacterial infections are common after liver resection. This study shows bacterial translocation occurs early, with higher rates after removing more liver tissue, increasing sepsis risk.
Area of Science:
- Hepatobiliary Surgery
- Surgical Infections
- Microbiology
Background:
- Bacterial infections are a significant complication following liver resection.
- Intra-abdominal sepsis occurred in 8% of patients post-hepatectomy in this cohort.
- Gut bacteria were frequently isolated from the abdominal cavity.
Purpose of the Study:
- To investigate the occurrence and timing of bacterial translocation after liver resection.
- To determine the relationship between the extent of hepatectomy and bacterial translocation.
- To assess the incidence of postoperative sepsis following liver resection.
Main Methods:
- Analysis of patient data from 138 major hepatectomy cases.
- Experimental study using rat models with varying percentages of liver resection (50%, 70%, 90%).
- Monitoring of mesenteric lymph node and blood cultures at different time points post-hepatectomy.
Main Results:
- Bacterial translocation was detected in mesenteric lymph nodes as early as 2 hours after major hepatectomy.
- Incidence of bacteremia increased with the extent of liver resection, reaching 100% after 90% hepatectomy.
- Positive blood cultures were observed in 6% of rats after 50% hepatectomy, indicating systemic spread.
Conclusions:
- Bacterial translocation is an early event following liver resection.
- The incidence and extent of bacterial translocation are directly proportional to the amount of liver tissue removed.
- These findings highlight the importance of monitoring for bacterial infections in the early postoperative period after hepatectomy.