Abstract
Background
Liver hypertrophy induced by partial portal vein occlusion (PVL) is accelerated by
adding simultaneous parenchymal transection (“ALPPS procedure”). This preclinical
experimental study in pigs tests the hypothesis that simultaneous ligation of portal
and hepatic veins of the liver also accelerates regeneration by abrogation of porto-portal
collaterals without need for operative transection.
Methods
A pig model of portal vein occlusion was compared with the novel model of simultaneous
portal and hepatic vein occlusion, where major hepatic veins draining the portal vein–deprived
lobe were identified with intraoperative ultrasonography and ligated using pledgeted
transparenchymal sutures. Kinetic growth was compared, and the portal vein system
was then studied after 7 days using epoxy casts of the portal circulation. Portal
vein flow and portal pressure were measured, and Ki-67 staining was used to evaluate
the proliferative response.
Results
Pigs were randomly assigned to portal vein occlusion (n = 8) or simultaneous portal and hepatic vein occlusion (n = 6). Simultaneous portal and hepatic vein occlusion was well tolerated and led to
mild cytolysis, with no necrosis in the outflow vein–deprived liver sectors. The portal
vein–supplied sector increased by 90 ± 22% (mean ± standard deviation) after simultaneous
portal and hepatic vein occlusion compared with 29 ± 18% after PVL (P < .001). Collaterals to the deportalized liver developed after 7 days in both procedures
but were markedly reduced in simultaneous portal and hepatic vein occlusion. Ki-67
staining at 7 days was comparable.
Conclusion
This study in pigs found that simultaneous portal and hepatic vein occlusion led to
rapid hypertrophy without necrosis of the deportalized liver. The findings suggest
that the use of simultaneous portal and hepatic vein occlusion accelerates liver hypertrophy
for extended liver resections and should be evaluated further.
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Article info
Publication history
Published online: October 25, 2018
Accepted:
September 13,
2018
Received in revised form:
September 9,
2018
Received:
April 24,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
