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Effects of intermittent Pringle’s manoeuvre on cirrhotic compared with normal liver. BJS 2010; 97: 1062-1069.

Published: 28th April 2010

Authors: Y. Sugiyama, Y. Ishizaki, H. Imamura, H. Sugo, J. Yoshimoto, S. Kawasaki et al.

Background

Although patients with liver cirrhosis are supposed to tolerate ischaemia–reperfusion poorly, the exact impact of intermittent inflow clamping during hepatic resection of cirrhotic compared with normal liver remains unclear.

Method

Intermittent Pringle's manoeuvre was applied during minor hepatectomy in 172 patients with a normal liver, 59 with chronic hepatitis and 97 with liver cirrhosis. To assess hepatic injury, delta (D)‐aspartate aminotransferase (AST) and D‐alanine aminotransferase (ALT) (maximum level minus preoperative level) were calculated. To evaluate postoperative liver function, postoperative levels of total bilirubin, albumin and cholinesterase (ChE), and prothrombin time were measured.

Results

Significant correlations between D‐AST or D‐ALT and clamping time were found in each group. The regression coefficients of the regression lines for D‐AST and D‐ALT in patients with normal liver were significantly higher than those in patients with cirrhotic liver. Irrespective of whether clamping time was 45 min or less, or at least 60 min, D‐AST and D‐ALT were significantly lower in patients with cirrhosis than in those with a normal liver. Parameters of hepatic functional reserve, such as total bilirubin, prothrombin time, albumin and ChE, were impaired significantly after surgery in patients with a cirrhotic liver.

Conclusion

Patients with liver cirrhosis had a smaller increase in aminotransferase levels following portal triad clamping than those with a normal liver. However, hepatic functional reserve in those with a cirrhotic liver seemed to be affected more after intermittent inflow occlusion. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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