Pringle Maneuver Deteriorates Gut Barrier Dysfunction Induced by Extended-Liver Radiofrequency Ablation
- 176 Downloads
Large volume radiofrequency ablation (RFA) of the liver disrupts intestinal mucosa barrier with subsequent bacterial translocation.
To investigate the effect of the Pringle maneuver applied concurrently with extended liver RFA on gut barrier integrity and bacterial translocation.
Materials and Methods
Rats were subjected to 30% liver RFA following laparotomy (group RFA), RFA plus 30 min Pringle (group RFA + P), Pringle (group P) or sham operation (group S). Intestinal tissue specimens were excised for histopathological examination and assessment of mucosal morphometry, apoptotic activity, mitotic activity and oxidative state. Tissue specimens were collected from the mesenteric lymph nodes, non-ablated liver parenchyma, kidneys and lungs for bacterial culture. Blood samples were collected from the portal and systemic circulation for endotoxin level measurement.
In group RFA + P, intestinal histopathologic lesions, mucosal atrophy and crypt cell apoptosis were more prominent compared to group RFA. Mitotic activity was suppressed. Oxidative stress was equally induced in all experimental groups. The incidence of positive bacterial cultures, bacterial counts and endotoxin levels were higher in group RFA + P compared to the other groups.
The application of the Pringle maneuver concurrently with extended liver RFA aggravates gut barrier dysfunction with more aggressive translocation of endotoxins and intestinal bacteria.
KeywordsRadiofrequency ablation Pringle Gut barrier Bacterial translocation
- 7.Dodd GD III, Napier D, Schoolfield JD, Hubbard L. Percutaneous radiofrequency ablation of hepatic tumors: postablation syndrome. Am J Roentgenol. 2005;185:51–57.Google Scholar
- 11.Chinn SB, Lee FT Jr, Kennedy GD, et al. Effect of vascular occlusion on radiofrequency ablation of the liver: results in a porcine model. Am J Roentgenol. 2001;176:789–795.Google Scholar
- 13.Lu DS, Raman SS, Vodopich DJ, Wang M, Sayre J, Lassman C. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the “heat sink” effect. Am J Roentgenol. 2002;178:47–51.Google Scholar
- 16.Lorente L, Aller MA, Rodriguez J, et al. Surgical anatomy of the liver in Wistar rats. Surg Res Commun. 1995;17:113–121.Google Scholar
- 17.Friberger P, Knos M, Mellstam L. A quantitative endotoxin assay utilizing LAL and a chromogenic substrate. In: Watson SW, Levin J, Novitsky TJ, eds. Endotoxins and their detection with the Limulus amebocyte lysate test. New York: Alan R. Liss; 1982:195–206.Google Scholar
- 23.Ypsilantis P, Lambropoulou M, Anagnostopoulos C, Tentes I, Tsigalou C, Pitiakoudis M, Kortsaris A, Papadopoulos N, Simopoulos C. Mesna preserves hepatocyte regenerating capacity following liver radiofrequency ablation under Pringle maneuver. J Surg Res. 2009 Oct 25 [Epub ahead of print].Google Scholar
- 24.Ypsilantis P, Papakostas C, Lambropoulou M, et al. Liver radiofrequency ablation leads to systemic inflammatory response in the rat. In: 23rd Northern Greek medical congress, Thessaloniki, 27–29th March 2008.Google Scholar