PRELIMINARY DATA ON INTERMITTENT PRINGLE (BARON) MANOEUVRE IN A CANINE MODEL GÁBOR 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 FORSCHUNG 27. SEMINAR DEZEMBER 2003, GOSAU, ÖSTERREICH

INTRODUCTION compression of the hepato-duodenal ligament trauma (seat belt, air bag) reconstructive operation of liver non traumatic liver resection Pringle (Baron) manoeuvre inflow occlusion hepatic ischaemia in collecting area of the portal vein stasis ischaemia-reperfusion injury local and systemic effect ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG 27. SEMINAR DEZEMBER 2003, GOSAU, ÖSTERREICH

BACKGROUND input side: portal vein-hepatic artery outflow way: hepatic vein system-lymphatic system indirect portal compression increased intraabdominal pressure (external compression, gravidity, blunt abdominal trauma, high pressure laparoscopic surgery, ascites) direct occlusion of portal triad local pathological alterations, surgical interventions target of the portal compression is not only the liver ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG 27. SEMINAR DEZEMBER 2003, GOSAU, ÖSTERREICH

MATERIALS AND METHODS I. Permission: Committee of Animal Research at University of Debrecen(N°11/2003) Animals: 5 mongrel dogs, kg (14.2 ± 2.38 kg) body weight 2-4 weeks of observation veterinary 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 FORSCHUNG 27. SEMINAR DEZEMBER 2003, GOSAU, ÖSTERREICH

MATERIALS AND METHODS II. Operation: left external jugular vein(V), left femoral artery(A) cannulation midline laparotomy hepatic vein (H) system cannulatation via inferior caval vein portal vein (P) cannulation via a mesenteric vein Pringle (Baron) manoeuvres (PM) with atraumatic clamps ischaemia periods: 3 times, minutes reperfusion periods: (RP) 5-5 minutes ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG 27. SEMINAR 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 for coagulation, haemorheological and chemical tests: external jugular vein (V) ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG 27. SEMINAR DEZEMBER 2003, GOSAU, ÖSTERREICH 1st PM2nd PM1st RP2nd RP 3rd PM 10 min 5 min 10 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 FORSCHUNG 27. SEMINAR DEZEMBER 2003, GOSAU, ÖSTERREICH 1st PM2nd PM1st RP2nd RP 3rd PM 10 min 5 min 10 min 5 min

RESULTS ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG 27. SEMINAR 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 ) * * ****

Haematocrit value [HCT] changes after Pringle (Baron) manoeuvres [PM] and reperfusion periods [RP] in blood samples from different points of circulation ( *p<0.05 ) 1st PM2nd PM3rd PM 1st RP2nd 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 ) 1st PM2nd PM3rd PM1st RP2nd RP * * * *

White blood cell count trend [WBC 50 ] changes standardised to 50% haematocrit after Pringle (Baron) manoeuvres [PM] and reperfusion periods [RP] in blood samples from different points of circulation

CONCLUSION After three time 10 minutes long Pringle (Baron) manoeuvre we found significant changes in systemic and local haematological and haemostasis parameters. This experimental hepatic ischaemia model is useable for further research to reduce the harmful consequences of liver injury and temporary inflow occlusion. ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG 27. SEMINAR DEZEMBER 2003, GOSAU, ÖSTERREICH

Thank you ! ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG 27. SEMINAR DEZEMBER 2003, GOSAU, ÖSTERREICH