PRELIMINARY DATA ON INTERMITTENT PRELIMINARY DATA ON INTERMITTENT PRINGLE (BARON) PRINGLE (BARON) MANOEUVREMANOEUVRE IN IN

A CANINE MODELA CANINE MODELGÁBOR ÁCS, NORBERT NÉMETH, ANDREA FURKA*,

JÓZSEF PAP-SZEKERES**, ADRIENN GULYÁS,JUDIT ZSÓTÉR, ISTVÁN FURKA, IRÉN MIKÓ

Department of Operative Techniques and Surgical Research,*2nd Department of Surgery University of Debrecen, Hungary

**Department of Surgery, County Hospital Kecskemét, Hungary

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

INTRODUCTIONcompression of the hepato-duodenal ligamenttrauma (seat belt, air bag) reconstructive operation of livernon traumatic liver resection

Pringle (Baron) manoeuvre

inflow occlusionhepatic ischaemiain collecting area of the portal vein stasisischaemia-reperfusion injurylocal and systemic effect

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

BACKGROUNDinput side: portal vein-hepatic artery outflow way: hepatic vein system-lymphatic system

indirect portal compressionincreased intraabdominal pressure(external compression, gravidity,blunt abdominal trauma,high pressure laparoscopic surgery,ascites)

direct occlusion of portal triadlocal pathological alterations, surgical interventions

target of the portal compression is not only the liver ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG

27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

MATERIALS AND METHODS I.Permission:

Committee of Animal Researchat University of Debrecen(N°11/2003)

Animals:5 mongrel dogs,12-15 kg (14.2 ± 2.38 kg) body weight2-4 weeks of observationveterinary care, mixed food,had free access to water, individual cages

Anaesthesia:ketamin (10 mg/kg)+xylasin hydrochloride (0.1 mg/kg)i.m., repeated in all 20 minutes with half dose

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

MATERIALS AND METHODS II.Operation:

left external jugular vein(V), left femoral artery(A) cannulation

midline laparotomyhepatic vein (H) system cannulatation via inferior caval

veinportal vein (P) cannulation via a mesenteric veinPringle (Baron) manoeuvres (PM) with atraumatic

clampsischaemia periods: 3 times, 10-10 minutesreperfusion periods: (RP) 5-5 minutes

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

MATERIALS AND METHODS III.

blood samples for haematological test: femoral artery (A), portal vein (P),

hepatic vein (H), external jugular vein (V)

blood samples forcoagulation, haemorheological and chemical tests:

external jugular vein (V)

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

1st PM 2nd PM1st RP 2nd RP 3rd PM

10 min 5 min 10 min10 min 5 min

MATERIALS AND METHODS IV.

blood tests:Sysmex F-800 microcell counter, Sysmex CA-500

automated coagulometer(TOA Medical Electronics Co. Ltd., Japan)

Hevimet-40 capillary viscosimeter (Hemorhex Ltd., Hungary)

FT-1 filtrometer (Carat Diagnostic Ltd., Hungary)

statistical analysis: SigmaStat (Jandel Scientific Co., Germany)

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

1st PM 2nd PM1st RP 2nd RP 3rd PM

10 min 5 min 10 min10 min 5 min

RESULTS

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

Red blood cell count [RBC] changes after Pringle (Baron) manoeuvres [PM] and reperfusion periods [RP] in blood samples

from different points of circulation (* p<0.05 )

6,0

7,0

8,0

9,0

FEMORALARTERY

PORTALVEIN

HEPATICVEIN

JUGULARVEIN

RB

C[T

/L] +

/- S.

D.

Base 1st PM 1st RP 2nd PM 2nd RP 3rd PM

*

*

** **

Haematocrit value [HCT] changes after Pringle (Baron) manoeuvres [PM] and reperfusion periods [RP] in blood samples

from different points of circulation ( *p<0.05 )

35,0

40,0

45,0

50,0

55,0

60,0

65,0

0 5 10 15 20 25 30 35 40TIME [minutes]

HC

T [%

] +/-

S.D

.

FEMORAL ARTERY PORTAL VEIN HEPATIC VEIN JUGULAR VEIN

1st PM 2nd PM 3rd PM1st RP 2nd RP

** * **

White blood cell count [WBC] changes after Pringle (Baron) manoeuvres [PM] and reperfusion periods [RP] in blood samples

from different points of circulation ( * p<0.05 )

2,5

5,0

7,5

10,0

12,5

15,0

0 5 10 15 20 25 30 35 40TIME [minutes]

WBC

[G/L

] +/-

S.D.

FEMORAL ARTERY PORTAL VEIN HEPATIC VEIN JUGULAR VEIN

1st PM 2nd PM 3rd PM1st RP 2nd RP

*

***

White blood cell count trend [WBC50] changes standardised to 50% haematocrit after Pringle (Baron) manoeuvres [PM] and

reperfusion periods [RP] in blood samples from different points of circulation

5,0

7,5

10,0

FEMORAL ARTERY PORTAL VEIN HEPATIC VEIN JUGULAR VEIN

WB

C50

[G/L

](HC

T=50

%)

Base 1st PM 1st RP 2nd PM 2nd RP 3rd PM

CONCLUSIONAfter three time 10 minutes long

Pringle (Baron) manoeuvre we found significant changes

in systemic and localhaematological and haemostasis

parameters.

This experimentalhepatic ischaemia model

is useable for further researchto reduce the harmful

consequencesof liver injury and temporary

inflow occlusion.

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH

Thank you !

ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH