Related Experiment Video
Updated: May 15, 2025
Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Portal flow modulation by splenic artery ligation to prevent posthepatectomy liver failure: A randomized controlled
Sunhawit Junrungsee1, Witcha Vipudhamorn2, Worakitti Lapisatepun3
1Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand.
Background:
Posthepatectomy liver failure is a serious clinical issue with high mortality, similar in pathophysiology to small-for-size syndrome seen in liver transplantation. This study evaluates the efficacy of splenic artery ligation in reducing posthepatectomy liver failure in patients with portal venous pressure >15 mm Hg after hepatectomy.
Methods:
This single-center, randomized controlled trial was conducted from May 2019 to November 2023. Eligible participants were patients scheduled for open hepatectomy for any indication. Patients with a portal venous pressure >15 mm Hg were randomized into splenic artery ligation and control groups in a 1:1 ratio. The primary outcomes were posthepatectomy liver failure grades B and C (International Study group of Liver Surgery criteria), and secondary outcomes included 90-day mortality, comprehensive complication index, and ascites volume.
Results:
The study was terminated early, before reaching the calculated sample size, because the primary outcome in the intervention group demonstrated statistically significant results. Of the 92 patients, 36 had elevated portal venous pressure, which was associated with greater rates of posthepatectomy liver failure grades B and C (41.67% vs 3.57%, P < .001), increased ascites volume (5,340 mL vs 1,055 mL, P < .001), and a greater comprehensive complication index (20.90 vs 8.70, P < .001). In the randomized subset, splenic artery ligation significantly reduced portal venous pressure and the portal venous pressure-central venous pressure gradient compared with both presplenic artery ligation values and the control group and significantly lowered the incidence of posthepatectomy liver failure grades B and C (16.67% vs 66.67%, P = .006), comprehensive complication index (8.70 vs 20.90, P = .034). Splenic artery ligation was identified as an independent factor in reducing posthepatectomy liver failure (adjusted relative risk, 0.29).
Conclusion:
Splenic artery ligation is effective in reducing posthepatectomy liver failure in patients with high portal venous pressure after hepatectomy.
