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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2024, vol. 30, issue4
Subject Area: Medicine
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DOI: 10.5272/jimab.2024304.5901
Published online: 06 December 2024
Original article
J of IMAB. 2024 Oct-Dec;30(4):5901-5904
POSTOPERATIVE PANCREATITIS IN HEPATIC RESECTIONS - ROLE OF PRINGLE'S MANEUVER
Radoslav Todorov1,2
, Emilia Tosheva1,2, Radko Tocev3, Atanas Yonkov1,2,
1)Department of General and Operative Surgery, Medical Faculty, Medical University Sofia, Bulgaria.
2)Clinic of General and Liver Pancreatic Surgery, University Hospital Alexandrovska, Sofia, Bulgaria.
3)Department of Obstetrician and Gynaecology, First Clinic of Gynaecology, University Hospital SBALAG "Maichin Dom" Sofia, Bulgaria.
ABSTRACT:
Background: The mechanism of postoperative pancreatitis still remains not profoundly explored in the area of liver resections. Three main mechanisms are named for the origin of pancreatitis following liver resections. The first mechanism has its foundation based on intrahepatic bile-ducts lithiasis, which leads to bile-stones or sludge migration during operation, obstructing the duodenal papilla The other mechanism elucidates haemobilia as the main factor, forming blood clots that migrate and obstruct the duodenal papilla. The Pringle maneuver is the third reason for pancreatitis, which causes blood congestion in the splanchnic area, particularly the pancreatic venous vessels.
Aim: to evaluate and define the leading mechanism of developing postoperative pancreatitis in liver resections by statistical retrospective analysis and explore the main complications following pancreatitis.
Methods: For the period from 2018 to 2023, 64 patients developed postoperative pancreatitis after liver resections. The study was conducted in a retrospective study fashion, exploring statistically the reasons and mechanisms leading to pancreatitis, comparing different factors like the type of liver resection, presence or lack of haemobilia, application of Pringle maneuver, time under warm ischemia utilizing the Pringle maneuver. Data was processed with SPSS ver 23.000
Results: Pancreatitis was found predominantly after atypical liver resections and bi-segmental resections. Haemobilia didn't prove to be a factor for pancreatitis. Warm ischemia and the time of its application proved to be one of the main factors for pancreatitis.
Conclusions: Warm ischemia and type of liver resection are the main factors leading to the development of pancreatitis.
Keywords: Liver resections, postoperative pancreatitis, Pringle maneuver,
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Please cite this article as: Todorov R, Tosheva E, Tocev R, Yonkov A. Postoperative Pancreatitis in Hepatic Resections - Role of Pringle’s Maneuver. J of IMAB. 2024 Oct-Dec;30(4):5901-5904. [Crossref - 10.5272/jimab.2024304.5901]
Correspondence to: Radoslav Slavchev Todorov, University Hospital for Active Treatment Alexandrovska, Clinic of General and Liver-Pancreatic Surgery Sofia; 1, Georgi Sofiyski Blvd., Sofia 1000, Bulgaria; E-mail: x_branko@abv.bg
REFERENCES:
1. Opie EL. The theory of retrojection of bile into the pancreas. Rev Surg. 1970 Jan-Feb;27(1):1-7. [PubMed]
2. Steer ML. Pancreas Divisum and Pancreatitis: Implications and Rationale for Treatment. In: Chronic Pancreatitis. Beger HG, Büchler M, Ditschuneit H, Malfertheiner P. (eds). Springer, Berlin, Heidelberg. 1990 pp 245-250. [Crossref]
3. Tocchi A, Mazzoni G, Liotta G, Lepre L, Costa G, Miccini M. [Increased blood amylase levels in the postoperative period after liver resection.] [in Italian] G Chir. 1998 Jun-Jul;19(6-7):262-4. [PubMed]
4. Abdalla EK, Noun R, Belghiti J. Hepatic vascular occlusion: which technique? Surg Clin North Am. 2004 Apr;84(2):563-85. [PubMed]
5. Kubota K, Makuuchi M, Noie T, Kusaka K, Sakamoto Y, Miki K, et al. Risk factors for hyperamylasemia after hepatectomy using the Pringle maneuver: randomized analysis of surgical parameters. Arch Surg. 1998 Mar;133(3):303-8. [PubMed]
6. Hashimoto N, Haji S, Nomura H, Ohyanagi H. Hyperamylasemia after hepatic resection. Hepatogastroenterology. 2003 Sep-Oct;50(53):1472-3. [PubMed]
7. Unalp OV, Aydin U, Yazici P, Nart D, Yenisey C, Kavak T, et al. The effects of the Pringle maneuver on the pancreas: can octreotide be protective? JOP. 2009 May 18;10(3):284-91. [PubMed]
8. Sathasivam S, Ritchie A, Brooks AJ, Morris DL. Acute pancreatitis following liver resection: report of three fatal cases and a review of the literature. ANZ J Surg. 2004 Aug;74(8):643-5. [ PubMed ]
9. Zdujic P, Bogdanovic A, Djindjic U, Kovac JD, Basaric D, Zdujic N, et al. Impact of prolonged liver ischemia during intermittent Pringle maneuver on postoperative outcome following liver resection. Asian J Surg. 2024 Mar 13:S1015-9584(24)00432-9. [PubMed]
10. An T, Wang Y, Liu L, Wang Y, Deng L, Wu M. Effect of Pringle maneuver on prognosis of patients with colorectal cancer liver metastases after liver resection: a meta-analysis. Langenbecks Arch Surg. 2024 Feb 6;409(1):53. [PubMed]
11. Ueda J, Mamada Y, Taniai N, Yoshioka M, Hirakata A, Kawano Y, et al. Massage of the Hepatoduodenal Ligament Recovers Portal Vein Flow Immediately After the Pringle Maneuver in Hepatectomy. World J Surg. 2020 Sep;44(9):3086-3092. [PubMed]
12. Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine (Baltimore). 2019 Apr;98(16):e15275. [PubMed]
13. Dancu GM, Popescu A, Sirli R, Danila M, Bende F, Tarta C, et al. The BISAP score, NLR, CRP, or BUN: Which marker best predicts the outcome of acute pancreatitis? Medicine (Baltimore). 2021 Dec 23;100(51):e28121. [PubMed]
14. Pando E, Alberti P, Mata R, Gomez MJ, Vidal L, Cirera A, et al. Early Changes in Blood Urea Nitrogen (BUN) Can Predict Mortality in Acute Pancreatitis: Comparative Study between BISAP Score, APACHE-II, and Other Laboratory Markers-A Prospective Observational Study. Can J Gastroenterol Hepatol. 2021 Mar 22;2021:6643595. [PubMed]
15. Liu G, Tao J, Zhu Z, Wang W. The early prognostic value of inflammatory markers in patients with acute pancreatitis. Clin Res Hepatol Gastroenterol. 2019 Jun;43(3):330-337. [PubMed]
16. Cui H, Mei C, Cui M, He Q, Song Y, Cui Z, et al. [Predictive value of serum chlorine and interleukin-6 combined with coagulation indexes on severity of severe acute pancreatitis.] [in Chinese] Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Dec;34(12):1301-1304. [PubMed]
17. Pan ZY, Yang Y, Zhou WP, Li AJ, Fu SY, Wu MC. Clinical application of hepatic venous occlusion for hepatectomy. Chin Med J (Engl). 2008 May 5;121(9):806-10. [PubMed]
18. Hotta T, Kobayashi Y, Taniguchi K, Johata K, Sahara M, Watanabe T, et al. Tanimura H. Hyperamylasemia after hepatectomy in chronic liver disease patients. Hepatogastroenterology. 2003 Jul-Aug;50(52):1060-5. [PubMed]
19. Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T, Hayashi K, Kasai H. Serum Amylase elevation following hepatic resection in patients with chronic liver disease. Am J Surg. 1996 Feb;171(2):235-8. [PubMed]
20. Sendler M, Weiss FU, Golchert J, Homuth G, van den Brandt C, Mahajan UM, et al. Cathepsin B-Mediated Activation of Trypsinogen in Endocytosing Macrophages Increases Severity of Pancreatitis in Mice. Gastroenterology. 2018 Feb;154(3):704-718.e10. [PubMed]
21. Hong W, Zheng L, Lu Y, Qiu M, Yan Y, Basharat Z, et al. Non-linear correlation between amylase day 2 to day 1 ratio and incidence of severe acute pancreatitis. Front Cell Infect Microbiol. 2022 Nov 22;12:910760. [PubMed]
22. Zheng L, Hong W, Geng W, Stock S, Pan J. A comparison of the BISAP score and Amylase and BMI (CAB) score versus for predicting severe acute pancreatitis. Acta Gastroenterol Belg. 2019 Jul-Sep;82(3):397-400. [PubMed ]
Received: 22 April 2024
Published online: 06 December 2024