Portal Venous Pressure Variation during Hepatectomy: A Prospective Study

Area of Science:

• Hepatobiliary Surgery
• Surgical Physiology
• Liver Transplantation

Background:

• Excessive portal venous pressure in the liver remnant is a known risk factor for posthepatectomy liver failure and small-for-size syndrome.
• Previous studies have not adequately considered baseline portal pressure before hepatectomy.
• Understanding portal pressure dynamics is crucial for improving patient outcomes after liver resection.

Purpose of the Study:

• To assess the impact of portal pressure changes during hepatectomy on patient outcomes.
• To identify the optimal cut-off for portal pressure variation that predicts adverse events.
• To investigate the relationship between portal pressure fluctuations and post-surgical complications.

Main Methods:

• Prospective observational study of 30 patients undergoing hepatectomy.
• Intraoperative measurement of portal pressure before and after the procedure.
• Statistical analysis including linear and logistic regression to identify outcome predictors.

Main Results:

• Portal pressure increase post-hepatectomy correlated with impaired coagulation and major complications within 30 days.
• Hepatic failure was significantly associated with increased portal pressure (p = 0.041).
• Multivariate analysis identified a portal venous pressure increase of ≥ 2 mmHg as an independent predictor of worse outcomes.

Conclusions:

• Portal pressure increase post-hepatectomy is a significant factor influencing patient outcomes, independent of liver remnant function.
• An increment of portal venous pressure ≥ 2 mmHg after hepatectomy appears to increase the risk of major complications.
• Findings may inform future strategies for modulating portal influx in liver surgery patients.