Effect of splenectomy on liver regeneration and function following partial hepatectomy: experimental study

The presence of enough remaining functioning liver parenchyma to avoid life-threatening postoperative liver failure is a major prerequisite for hepatic resection in patients with hepato biliary carcinoma. There are clinical reports which confirm the beneficial clinical effects of splenectomy on integrity of the residual liver following liver resection for hepatocellular carcinoma in cirrhotic patients with hypersplenism and portal hypertension. This experimental study was designed on hamsters to evaluate the proliferative capacity and function of the remaining liver lobes; in which splenectomy was done simultaneously with partial hepatectomy compared with those in which splenectomy was not done. Forty hamsters were divided into two groups: GI; in which partial hepatectomy was performed without splenectomy and the GIl; in which animals were subjected to partial hepatectomy with prior splenectomy. Animals from each group were subjected to liver biopsy from the remaining lobes 48, 72 hours and one week after surgery. Also, serum alanine aminotransferase [ALT] and total bilirubin were tested before, 48, 72 hours and one week after hepatectomy. Hepatic regeneration in the remaining lobes was assessed through histo-pathological study, DNA ploidy of the hepatic nuclei using computerized image analysis system and determining of the labeling index of the nuclear factor NF Kappa B [P105], a novel monoclonal antibody specific for P105 protein by immunohistochemistry. In GIl: induction of NK kappa B [PI05] labeling index showed maximum expression depending on the regenerative capacity of the remaining liver lobes. In contrast, in GI; liver regeneration was slow. Also, changes in liver function of Gil indicated that splenectomy prior hepatecotomy may minimize dysfunction in the remaining hypertrophied liver lobes

effect of portal vein branch plus heterochronous hepatic artery branch ligation on liver regeneration [Experimental study]

The proliferative capacity of non-ligated liver lobes was designned experimental study on dogs in which portal vein and hepatic artery ligation was done either simultaneously or heterochronously. Dogs were divided into four groups: G I [control G]; laparotomy was performed without vascular ligation, G II; dogs were subjected to ligation of the right lateral and median branches of portal vein alone, G III, dogs were subjected to hepatic artery branches ligation 48h after portal vein branches ligation. G IV, dogs were subjected to ligation of the same branches of the portal vein and hepatic artery simultaneously. Dogs from each group were subjected to a liver biopsy before and 24, 48, 72, and 168h [one week] after surgery. Standard serum liver functions were tested before ligation, 72 hs and one week after ligation. Hepatic regeneration in the non-ligated lobe was assessed through histopathological study, DNA quantitation of the hepatic nuclei by the computerized image analysis system and estimation of proliferation marker in hepatic tissue. In this study, the labeling index of the nuclear factor NF Kappa B [PI05], a novel monoclonal antibody specific for PI05 protein, was determined immunohistochemically. Results showed induction of the NK kappa B [P105] labeling index showed maximum levels G III. Quantitative determination of serum glutamicoxaloacetate transaminase [GOT] showed peak levels in G IV at 24h after surgery. Our finding for this index that heterochronous partial portal vein and hepatic artery ligation [i.e., G III] is effecttive, because this procedure leads to an increase in the compensatory hypertrophy of the nonligated liver lobes that depends on the regenerative capacity of the lobes themselves. In contrast, in G IV [i.e., synchronous ligation of portal vein and hepatic artery branches] liver regeneration did not occur due to the severe systemic damage induced by infectious necrosis in the ligated lobe. The serial changes in liver function in G III indicate that the use of this technique may minimize dysfunction in the remaining hypertrophied liver lobes, similar to findings in G II. So, the PVBL plus heterochronous HABL procedure is safer and more effective than PVBL alone, or PVBL plus simultaneous HABL. A better knowledge of the events following such heterochronous ligation should improve the clinical outcome of hepatic resection for liver diseases