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Predictors of early regeneration in remnant liver volume after anatomical hepatic resection
Electronic Poster Abstracts
EP01D-074 LAPAROSCOPIC TREATMENT OF CYSTIC LIVER LESIONS H. Maghrebi1, A. El Heni1, R. Rhaim2, A. Makni2, A. Daghfous2, F. Fteriche2, F. Chebbi2, R. Ksantini2, M. Jouini2, M. Kacem2 and Z. Bensafta2 1 Surgery A, and 2Rabta Hospital, Tunisia Background: Ciliated hepatic foregut cyst is a congenital anomaly arising from the embryologic foregut. It is usually asymptomatic but may presents with vague abdominal symptoms. Fewer than 100 cases have been described in the literature. Study aims: To insist on the rarity of this pathology. Cases: We present herein the laparoscopic Treatment of cystic liver lesions through the case of ciliated hepatic foregut cysts, where the diagnosis was established after laparoscopic resection. The patient recovered well after the procedure. Conclusion: Although it is rare, CHFC should be included in the differential diagnosis of cystic lesions of the liver and is important to consider in biopsies obtained for the evaluation of possible neoplastic lesions.
EP01E e Electronic Poster: 1E e Liver Miscellaneous
EP01E-001 LEVOSIMENDAN: DOES THIS CARDIOVASCULAR DRUG REALLY PREVENT LIVER ISCHEMIAREPERFUSION INJURY? AN EXPERIMENTAL STUDY ON PIGS 1 ,2 3 cka2 Z. Subrt , V. Cerný , Z. Turek3, A. Ferko2 and F. Ce 1 Department of Military Surgery, Faculty of Military Health Sciences, University of Defense, 2Department of Surgery, and 3Department of Anesthesiology and Resuscitation, University Hospital and Medical Faculty of Charles University, Czech Republic Introduction: Temporary clamping of the hepatoduodenal ligament during hepatectomy induces ischemic-reperfusion injury of the remnant liver that can theoretically lead to liver failure after surgery. Levosimendan is a positive inotropic drug, which induces preconditioning-like adaptive mechanisms by opening mitochondrial KATP channels. Present clinical application is in cardiovascular surgery, but several experimental studies in a rat model demonstrated positive effect on liver ischemia-reperfusion injury. Methods: Female domestic pigs (n = 17) weighing 42 5 kg were divided into two groups e levosimendan group (n = 9) and control group (n = 8). Levosimendan was administered one hour before incision. 60 minutes of liver ischemia was applied by clamping of hepatoduodenal ligament and right hepatectomy was performed in both groups. Hemodynamic changes, coagulation parameters levels and plasma levels of ALT, AST, bilirubin and lactate dehydrogenase were measured after surgery, 1st, 3rd, 5th and 7th postoperative day. The animals were explored and euthanased after 7 days. Results: There were no postoperative deaths in Levosimendan group, 2 pigs in control group died because of hemodynamic instability and cardiovascular failure
HPB 2016, 18 (S1), e1ee384
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immediately after liver resection. The differences in hemodynamic changes, coagulation parameters levels and plasma levels of ALT, AST, bilirubin and lactate dehydrogenase were not statistically significant. Conclusion: The experimental study didn’t demonstrate levosimendan positive effect on liver ischemia-reperfusion injury by evaluation of routine clinical and laboratory parameters. The work was supported by the Ministry of Health e RVO (FN HK, 00179906) and Ministry of Defense “Longterm development plan for the organization in 1011”.
EP01E-002 PREDICTORS OF EARLY REGENERATION IN REMNANT LIVER VOLUME AFTER ANATOMICAL HEPATIC RESECTION S. W. Ahn1, J. D. Yang1, O. H. Park1, H. C. Yu1, B. H. Cho1 and S. E. Hwang2 1 Surgery, Chonbuk National University Medical School, and 2Daejeon Sun Hospital, Republic of Korea Introduction: The aim of this study is to investigate whether early liver volume regeneration rate after anatomical hepatic resection is related to future remnant liver volume (FRLV) and clinicopathologic factors. Method: This prospective study included 63 patients (54 with malignant and 9 with benign liver diseases) with a mean age of 58.9 years who underwent hepatectomy from October 2012 until April 2015.In this study, age, gender, BMI, and LFT (including ApoA1 and prealbumin) were considered as potential predictors of liver regeneration. FRLV was preoperatively calculated based on CT volumetry with a virtual surgical cut performed by Dr. Liver. The ApoA1 and prealbumin levels were examined on the 1st, 5th, and 7th postoperative day. Liver CT volumetry was performed on the 7th and 21st day after surgery by Dr. Liver. Postoperative fibrotic change was pathologically measured. Results: The mean liver regeneration rates were 24.6% and 6.8% for POD7 and POD21, respectively. No statistically significant correlation was found between ApoA1/prealbumin and liver regeneration rate (p > 0.05). A stepwise multiple regression analysis showed that a smaller FRLV resulted in a larger liver regeneration rate (Coefficient = 0.84, p < 0.001) on POD 7 and POD 21. Pathologically, fibrotic liver had a significantly larger liver regeneration rate than normal liver on POD7 (p < 0.05) but not on POD 21. Conclusions: This study suggested a smaller FRLV and more hepatic fibrosis can be used as predictors of early liver regeneration after anatomical hepatic resection. However, a larger population is needed for further validation of these findings.
EP01E-003 A CRITICAL APPRAISAL OF THE ISGLS DEFINITION FOR BILIARY LEAKAGE FOLLOWING HEPATIC RESECTION R. Linke, W. O. Bechstein and A. Schnitzbauer Department of Abdominal and Visceral Surgery, Frankfurt University Hospital, Goethe University, Germany
EP01D-074 LAPAROSCOPIC TREATMENT OF CYSTIC LIVER LESIONS H. Maghrebi1, A. El Heni1, R. Rhaim2, A. Makni2, A. Daghfous2, F. Fteriche2, F. Chebbi2, R. Ksantini2, M. Jouini2, M. Kacem2 and Z. Bensafta2 1 Surgery A, and 2Rabta Hospital, Tunisia Background: Ciliated hepatic foregut cyst is a congenital anomaly arising from the embryologic foregut. It is usually asymptomatic but may presents with vague abdominal symptoms. Fewer than 100 cases have been described in the literature. Study aims: To insist on the rarity of this pathology. Cases: We present herein the laparoscopic Treatment of cystic liver lesions through the case of ciliated hepatic foregut cysts, where the diagnosis was established after laparoscopic resection. The patient recovered well after the procedure. Conclusion: Although it is rare, CHFC should be included in the differential diagnosis of cystic lesions of the liver and is important to consider in biopsies obtained for the evaluation of possible neoplastic lesions.
EP01E e Electronic Poster: 1E e Liver Miscellaneous
EP01E-001 LEVOSIMENDAN: DOES THIS CARDIOVASCULAR DRUG REALLY PREVENT LIVER ISCHEMIAREPERFUSION INJURY? AN EXPERIMENTAL STUDY ON PIGS 1 ,2 3 cka2 Z. Subrt , V. Cerný , Z. Turek3, A. Ferko2 and F. Ce 1 Department of Military Surgery, Faculty of Military Health Sciences, University of Defense, 2Department of Surgery, and 3Department of Anesthesiology and Resuscitation, University Hospital and Medical Faculty of Charles University, Czech Republic Introduction: Temporary clamping of the hepatoduodenal ligament during hepatectomy induces ischemic-reperfusion injury of the remnant liver that can theoretically lead to liver failure after surgery. Levosimendan is a positive inotropic drug, which induces preconditioning-like adaptive mechanisms by opening mitochondrial KATP channels. Present clinical application is in cardiovascular surgery, but several experimental studies in a rat model demonstrated positive effect on liver ischemia-reperfusion injury. Methods: Female domestic pigs (n = 17) weighing 42 5 kg were divided into two groups e levosimendan group (n = 9) and control group (n = 8). Levosimendan was administered one hour before incision. 60 minutes of liver ischemia was applied by clamping of hepatoduodenal ligament and right hepatectomy was performed in both groups. Hemodynamic changes, coagulation parameters levels and plasma levels of ALT, AST, bilirubin and lactate dehydrogenase were measured after surgery, 1st, 3rd, 5th and 7th postoperative day. The animals were explored and euthanased after 7 days. Results: There were no postoperative deaths in Levosimendan group, 2 pigs in control group died because of hemodynamic instability and cardiovascular failure
HPB 2016, 18 (S1), e1ee384
e287
immediately after liver resection. The differences in hemodynamic changes, coagulation parameters levels and plasma levels of ALT, AST, bilirubin and lactate dehydrogenase were not statistically significant. Conclusion: The experimental study didn’t demonstrate levosimendan positive effect on liver ischemia-reperfusion injury by evaluation of routine clinical and laboratory parameters. The work was supported by the Ministry of Health e RVO (FN HK, 00179906) and Ministry of Defense “Longterm development plan for the organization in 1011”.
EP01E-002 PREDICTORS OF EARLY REGENERATION IN REMNANT LIVER VOLUME AFTER ANATOMICAL HEPATIC RESECTION S. W. Ahn1, J. D. Yang1, O. H. Park1, H. C. Yu1, B. H. Cho1 and S. E. Hwang2 1 Surgery, Chonbuk National University Medical School, and 2Daejeon Sun Hospital, Republic of Korea Introduction: The aim of this study is to investigate whether early liver volume regeneration rate after anatomical hepatic resection is related to future remnant liver volume (FRLV) and clinicopathologic factors. Method: This prospective study included 63 patients (54 with malignant and 9 with benign liver diseases) with a mean age of 58.9 years who underwent hepatectomy from October 2012 until April 2015.In this study, age, gender, BMI, and LFT (including ApoA1 and prealbumin) were considered as potential predictors of liver regeneration. FRLV was preoperatively calculated based on CT volumetry with a virtual surgical cut performed by Dr. Liver. The ApoA1 and prealbumin levels were examined on the 1st, 5th, and 7th postoperative day. Liver CT volumetry was performed on the 7th and 21st day after surgery by Dr. Liver. Postoperative fibrotic change was pathologically measured. Results: The mean liver regeneration rates were 24.6% and 6.8% for POD7 and POD21, respectively. No statistically significant correlation was found between ApoA1/prealbumin and liver regeneration rate (p > 0.05). A stepwise multiple regression analysis showed that a smaller FRLV resulted in a larger liver regeneration rate (Coefficient = 0.84, p < 0.001) on POD 7 and POD 21. Pathologically, fibrotic liver had a significantly larger liver regeneration rate than normal liver on POD7 (p < 0.05) but not on POD 21. Conclusions: This study suggested a smaller FRLV and more hepatic fibrosis can be used as predictors of early liver regeneration after anatomical hepatic resection. However, a larger population is needed for further validation of these findings.
EP01E-003 A CRITICAL APPRAISAL OF THE ISGLS DEFINITION FOR BILIARY LEAKAGE FOLLOWING HEPATIC RESECTION R. Linke, W. O. Bechstein and A. Schnitzbauer Department of Abdominal and Visceral Surgery, Frankfurt University Hospital, Goethe University, Germany