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Serum Amylase elevation following hepatic resection in patients with chronic liver disease
S Miyagawa1, M Makuuchi, S Kawasaki
1First Department of Surgery, Shinshu University, School of Medicine, Matsumoto, Japan.
Insights
Prolonged Pringle maneuver during hepatectomy increases risk of hyperamylasemia and pancreatitis in liver disease patients. Shorter occlusion times reduce these potential complications.
Area of Science:
- Hepatobiliary Surgery
- Gastroenterology
- Surgical Complications
Background:
- Investigated factors contributing to hyperamylasemia post-hepatectomy in 140 patients with chronic liver disease.
- Focused on patients with pre-existing liver conditions undergoing liver resection.
Purpose of the Study:
- To identify risk factors for elevated serum amylase levels following hepatectomy.
- To assess the impact of different vascular occlusion techniques on postoperative amylase levels.
Main Methods:
- Retrospective study of 140 patients undergoing hepatectomy.
- Comparison of three groups: Pringle maneuver (n=113), hemihepatic vascular occlusion (n=21), and no vascular occlusion (n=6).
Main Results:
- Significant postoperative hyperamylasemia observed in the Pringle group compared to preoperative levels.
- No significant amylase elevation in hemihepatic or no-occlusion groups.
- Longer vascular occlusion times in the Pringle group correlated with higher amylase elevations and risk of pancreatitis.
Conclusions:
- Prolonged portal congestion during hepatectomy is a risk factor for hyperamylasemia.
- Extended occlusion times increase the likelihood of pancreatitis in patients with underlying liver disease.
- Careful management of vascular occlusion duration is crucial to minimize postoperative complications.
Background:
Factors liable to cause hyperamylasemia after hepatectomy were studied retrospectively in 140 patient with chronic liver disease.
Methods:
The pringle maneuver was performed in 113 patients (Pringle group), the hemihepatic vascular occlusion technique in 21 (hemihepatic group), and no vascular occlusion in 6 (no-occlusion group).
Results:
In the Pringle group, postoperative serum amylase levels were elevated significantly in comparison with the preoperative levels, but were not elevated in hemihepatic and no-occlusions groups. In the Pringle group, there were 4 patients whose postoperative serum amylase levels exceeded 3.5 times the upper limit of the normal range together with serum pancreatic isoamylase or lipase elevation or both. When compared with the other 109 patients, these 4 patients had a significantly longer vascular occlusion time (51 +/-3 minutes versus 94 +/- 8 minutes P<0.005). One of them developed pancreatitis and died from hepatic failure.
Conclusion:
Prolongation of portal congestion carries a potential risk of serum amylase elevation and pancreatitis after hepatectomy in patients with underlying liver disease.