Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits
Background The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle’s maneuver), continuous prolonged clamping results in liver ischemia. Objectiv...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Kashan University of Medical Sciences
2015-11-01
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| Series: | Archives of Trauma Research |
| Online Access: |
http://archtrauma.com/?page=article&article_id=30244
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| _version_ | 1797714298336706560 |
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| author | Kolahdoozan Behdad Hosseinpour Behdad Rezaei |
| author_facet | Kolahdoozan Behdad Hosseinpour Behdad Rezaei |
| author_sort | Kolahdoozan |
| collection | DOAJ |
| description | Background
The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle’s maneuver), continuous prolonged clamping results in liver ischemia.
Objectives
The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models.
Materials and Methods
In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers.
Results
There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation.
Conclusions
Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver. |
| first_indexed | 2024-03-12T07:49:36Z |
| format | Article |
| id | doaj.art-2d45f5057ef24d92a021278f2c79e6b3 |
| institution | Directory Open Access Journal |
| issn | 2251-953X 2251-9599 |
| language | English |
| last_indexed | 2024-03-12T07:49:36Z |
| publishDate | 2015-11-01 |
| publisher | Kashan University of Medical Sciences |
| record_format | Article |
| series | Archives of Trauma Research |
| spelling | doaj.art-2d45f5057ef24d92a021278f2c79e6b32023-09-02T20:40:06ZengKashan University of Medical SciencesArchives of Trauma Research2251-953X2251-95992015-11-014410.5812/atr.30244Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in RabbitsKolahdoozanBehdadHosseinpourBehdadRezaeiBackground The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle’s maneuver), continuous prolonged clamping results in liver ischemia. Objectives The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models. Materials and Methods In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers. Results There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation. Conclusions Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver. http://archtrauma.com/?page=article&article_id=30244 |
| spellingShingle | Kolahdoozan Behdad Hosseinpour Behdad Rezaei Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits Archives of Trauma Research |
| title | Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits |
| title_full | Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits |
| title_fullStr | Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits |
| title_full_unstemmed | Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits |
| title_short | Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits |
| title_sort | evaluation of the safe ischemic time of clamping during intermittent pringles maneuver in rabbits |
| url |
http://archtrauma.com/?page=article&article_id=30244
|
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