Portal Venous Hemodynamic Changes After Hepatectomy
Study Details
Study Description
Brief Summary
The aim of this study is to investigate the pathophysiological mechanisms underlying the formation of posthepatectomy ascites with a focus on the significance of changes in portal venous hemodynamics after hepatic resection. By evaluation of other factors that may be involved in the formation of ascites this study may help to show to what extent the increase of portal venous pressure contributes to ascites formation. Detailed knowledge about pathogenetic factors concerning the formation of postoperative ascites might help preventing protracted hospital stay and further inconveniences to the patient.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Detailed Description
The mechanisms underlying the development of large-volume ascites after hepatectomy remain poorly understood. While studies on animal models suggest an increase of portal venous pressure after hepatectomy that may in turn favor the transudation of fluid into the peritoneal cavity further factors may be critically involved in the postoperative formation of ascites. These factors may include a drop in serum protein levels (and colloid osmotic pressure), a transient impairment in renal function and a surgery-induced capillary leakage. However, a better knowledge of the pathophysiology represents the prerequisite for efficient treatment.
In the present study the impact of changes in hepatic hemodynamics after hepatectomy on development of ascites will be investigated. Enrolled patients will receive measurement of portal venous flow and pressure as well as hepatic artery flow before and after hepatic resection. Associations of changes in these parameters with development of postoperative ascites and further postoperative complications will be evaluated.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Major hepatic resection Patients undergoing resection of > 2 liver segments |
Procedure: Portal venous pressure
Portal venous pressure is measured by invasive means using an arterial canula
Procedure: Portal venous flow
Portal venous flow is measures using a noninvasive method (Doppler flow meter)
Procedure: Hepatic artery flow
Hepatic artery flow will be measured using a noninvasive method (Doppler flow meter)
|
| Minor hepatic resection Patients undergoing resection of </= 2 liver segments |
Procedure: Portal venous pressure
Portal venous pressure is measured by invasive means using an arterial canula
Procedure: Portal venous flow
Portal venous flow is measures using a noninvasive method (Doppler flow meter)
Procedure: Hepatic artery flow
Hepatic artery flow will be measured using a noninvasive method (Doppler flow meter)
|
| Control group Patients undergoing exploratory laparotomy for hepatobiliary disease without resection (e.g. due to inoperable disease) |
Procedure: Portal venous pressure
Portal venous pressure is measured by invasive means using an arterial canula
Procedure: Portal venous flow
Portal venous flow is measures using a noninvasive method (Doppler flow meter)
Procedure: Hepatic artery flow
Hepatic artery flow will be measured using a noninvasive method (Doppler flow meter)
|
Outcome Measures
Primary Outcome Measures
- Postoperative ascites [7 days]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients scheduled for elective hepatic resection
-
Age equal or greater than 18 years
-
Informed consent
Exclusion Criteria:
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Evidence of ascites or hypalbuminemia preoperatively
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Renal insufficiency
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Expected lack of compliance
-
Impaired mental state or language problems
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Department of General, Visceral and Transplantation Surgery | Heidelberg | Germany | 69120 |
Sponsors and Collaborators
- Heidelberg University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- NNR-4