TEMPORARY PORTACAVAL SHUNT IMPROVES THE OUTCOME OF CONTINUOUS NORMOTHERMIC LIVER ISCHEMIA

Mousa Atta, Hussein; Mohamed Ibrahim, Ibrahim; Osman, Ahmed; Khalil Ibrahim, Adel

doi:10.21608/ejsur.2000.378217

TEMPORARY PORTACAVAL SHUNT IMPROVES THE OUTCOME OF CONTINUOUS NORMOTHERMIC LIVER ISCHEMIA

Document Type : Original Article

Authors

¹ Department of Surgery, Faculty of Medicine, El-Minia University, El-Minia

² Department of †Veterinary Surgery and Anesthesiology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt

³ Pathology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt

⁴ Clinical Pathology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt

10.21608/ejsur.2000.378217

Abstract

Warm liver ischemia is induced whenever hepatic pedicle clamping performed during liver surgery to minimize operative
blood loss. The contributory role of intestinal congestion and injury, that follows prolonged hepatic pedicle occlusion, in
aggravating liver ischemic injury and in inducing remote organ injury is underscored. The hepatic pedicles of twelve dogs were continuously interrupted for 90 minutes. In six dogs portacaval shunts were constructed prior to hepatic pedicle
occlusion. Two dogs in the control group and all dogs in the shunt group survived for 24 hours after reperfusion (p < 0.05).
Serum ALT concentrations at 1 and 24 h after reperfusion were significantly higher (p <0.001) in the control versus shunt
group. Significantly more severe histologic injuries were demonstrated in the liver (grade 4 versus grade 1 respectively, p < 0.005) and the intestine (grade 7 versus grade 1 respectively, p < 0.005) of the control versus the shunt group. The lung and kidney showed morphologic features of acute inflammatory injury in the control but not in the shunt group. We conclude that portacaval shunts, by preventing gut congestion and injury, improve tolerance of the liver to prolonged continuous warm ischemia and prevent its systemic effects on distant organs.