How much ischemia can the liver tolerate during resection?

Hepatobiliary Surgery and Nutrition
Wouter G van RielT M van Gulik

Abstract

The use of vascular inflow occlusion (VIO, also known as the Pringle maneuver) during liver surgery prevents severe blood loss and the need for blood transfusion. The most commonly used technique for VIO entails clamping of the portal triad, which simultaneously occludes the proper hepatic artery and portal vein. Although VIO is an effective technique to reduce intraoperative blood loss, it also inevitably inflicts hepatic ischemia/reperfusion (I/R) injury as a side effect. I/R injury induces formation of reactive oxygen species that cause oxidative stress and cell death, ultimately leading to a sterile inflammatory response that causes hepatocellular damage and liver dysfunction that can result in acute liver failure in most severe cases. Since the duration of ischemia correlates positively with the severity of liver injury, there is a need to find the balance between preventing severe blood loss and inducing liver damage through the use of VIO. Although research on the maximum duration of hepatic ischemia has intensified since the beginning of the 1980s, there still is no consensus on the tolerable upper limit. Based on the available literature, it is concluded that intermittent and continuous VIO can both be used safely when...Continue Reading

Citations

Dec 19, 2017·Frontiers in Physiology·Bruno ChristNavina Waschinsky
Jan 20, 2018·Langenbeck's Archives of Surgery·F RassamT M van Gulik
Mar 25, 2019·Oxidative Medicine and Cellular Longevity·Thomas SenonerFlorian Primavesi
Jun 1, 2018·International Journal of Endocrinology·Simón Quetzalcóatl Rodríguez-LaraAlejandra Guillermina Miranda-Díaz
Dec 13, 2019·Oxidative Medicine and Cellular Longevity·Tao ZhangJiliang Wang
Oct 23, 2020·Current Urology Reports·Alireza Ghoreifi, Hooman Djaladat

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