Inflammation and Coagulation Interaction After Open and Laparoscopic Left Partial Hepatectomy in a Porcine Experimental Model

Constantinos S. Mammas, MD MSc PhD, Maria Kostoglou, Assistant Professor, George Kottis, Associate Professor, Chryssa Nikolaou, Associate Professor, Nicolaos Arkadopoulos, Assistant Professor, Nicolaos Kavantzas, Assistant Professor, Ismene Dontas, Professor, Antonios Analytis, MathematicianStatistician, George Arsenis, Associate Professor, Spyros Dourakis, Professor, Vasileios Smyrniotis, Professor. National and Kapodistrian University of Athens, Surgical Laboratory C.TOUNTAS


Objectives: The project compares the systemic and regional inflammation to the coagulation response between Open (OLPH) and Laparoscopic (LLPH), left partial hepatectomy in a porcine model. Materials and Methods: Twenty-nine (N=29) domestic pigs (21-32kg), were randomly allocated into two groups, the open (N1=19) undergoing OLPH using a knife (A, n=13) or a radiofrequency knife (RF knife) (B, n=6) and the laparoscopic (N2=10) undergoing LLPH using a stapler (C, n=5) or a stapler and a Radio-Frequency knife (RF knife) (D, n=5), under general anaesthesia. By blood samples before (PD), after (PD0) operation, on the 1st (PD1) and on the 7th (PD7) postoperative day Hematological, Biochemical, Coagulation, Hormonal, Immunological parameters were measured. By two series of 29 stained liver tissue sections, taken on PD0 and on PD7 respectively, a regional inflammatory and a regional necrosis index were estimated by microscopic visualization. Results: Systemic and liver regional inflammation and coagulation analysis resulted in the following statistically significant differences: 1) CRPPD7(B>D, p=.005), 2) Cortisol       (A PD0>C PD0, p=.002) and  (B PD7>C PD7, p=.004),  3)Fibrinogen (B PD7<CPD7, p=.0041) , 4) PLTPD7(B<D, p=.001) and (C<D, p=.002), 5) aPTTPD1 (D>A, p=.004). Conclusions: In the porcine model, only the systemic and not the liver regional inflammatory response seems to be more increased and extended, after OLPH and specially if an RF knife is used for liver resection (B). Coagulation seems to be significantly influenced in the early and the late postoperative period in the laparoscopic groups, irrelevantly to the systemic inflammatory response.

Session Number: Poster – Poster Presentations
Program Number: P604
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