Bacterial translocation, endotoxaemia and apoptosis following Pringle manoeuvre in rats.
BACKGROUND
Intraoperative occlusion of the hepatoduodenal ligament (Pringle manoeuvre (Pm)) is often employed for the reduction of blood loss during liver surgery. No data exist to date on the effects of Pm on mucosal barrier dysfunction, systemic bacterial translocation (BT), endotoxaemia and apoptosis.


METHODS
Sixty-five male Wistar rats in three groups: I (n=25) controls, II (n=20) sham operation, III (n=20) occlusion of the hepatoduodenal ligament (Pm). Tissue samples from mesenteric lymph nodes (MLNs), liver, lungs and spleen were analysed after 30 min and at 24 h. Endotoxin was measured in portal and aortic blood and routine haematological and biochemical parameters were measured before and after Pm.


RESULTS
No differences were found in the blood parameters before and after Pm, but a significant increase in contaminated MLNs and liver was noted. All cultured bacteria were enteric in origin. Portal and aortic endotoxin were significantly increased. Overall the ileal architecture remained intact in all specimens studied and no significant pathology was observed. The ABC increased after Pm significantly (P<0.01).


CONCLUSIONS
Normothermic Pm of 30 min duration results in immediate and delayed gut barrier failure by significantly increasing BT and endotoxaemia which might be attributed to portal stasis leading to intestinal congestion as well as temporary liver ischaemia. Apoptosis increased significantly 30 min after performing the Pm.
Filos
Kriton S
KS
Department of Anaesthesiology and Critical Care Medicine, School of Medicine, University of Patras, Patras, Greece.
Kirkilesis
Ioannis
I
Spiliopoulou
Iris
I
Scopa
Chrisoula D
CD
Nikolopoulou
Vassiliki
V
Kouraklis
Gregory
G
Vagianos
Constantine E
CE
D000818:Animals; D017209:Apoptosis; D018988:Bacterial Translocation; D001646:Bile / Q000382:microbiology; D002432:Cecum / Q000382:microbiology; D003250:Constriction; D046508:Culture Techniques; D004195:Disease Models, Animal; D019446:Endotoxemia / Q000209:etiology*; D006488:Hemostasis, Surgical / Q000009:adverse effects*; D007082:Ileum / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology; D008099:Liver / Q000382:microbiology; D008198:Lymph Nodes / Q000382:microbiology; D008297:Male; D008643:Mesentery; D051381:Rats; D017208:Rats, Wistar