Journal of Liver: Krankheit und Transplantation

Early Changes in Smallfor- Flow Syndrome: An Experimental Model

Asencio JM, Steiner MA, G Sabrido JL, Lopez Baena JA, Ferreiroa JP, Morales A, Lozano P, Peligros I, Laso J, Herrero M, Lisbona C, Perez-Pena JM and Olmedilla L

Early Changes in Smallfor- Flow Syndrome: An Experimental Model

The aim of the present study is to present an experimental model of the early changes in hemodynamic and histological values after hyperextended hepatectomy. Intraoperative findings are important, because early control of damage could prevent the development of small-for-flow syndrome. Sequential liver segmentectomy was performed under general anesthesia in 11 minipigs until 80% of the parenchyma was resected. After each resection, histological samples of remnant parenchyma were taken and values recorded for portal flow, portal pressure, arterial hepatic flow, suprahepatic vein pressure, arterial pressure, and cardiac frequency. This hyperextended hepatectomy model reproduces the changes observed in small-for-flow syndrome. The hemodynamic and histological changes observed are immediate; therefore, they should be prevented during surgery by modulating pressure and portal flow. Intraoperative measurement of pressure and portal flow should be part of the therapeutic and diagnostic algorithms of patients who undergo major hepatic resection.