The effects of the Pringle maneuver on the pancreas: can octreotide be protective?
OBJECTIVE
The aim of this study was to evaluate the negative effects of the Pringle maneuver on pancreatic tissue with respect to the time of performing the maneuver. Moreover, the efficacy of octreotide therapy on pancreatic changes at the time of the Pringle maneuver was assessed.


METHODS
Fifty male Wistar Albino rats were randomized into 5 groups.


METHODS
The groups were formed as follows: Group A: sham operation, Group B: Pringle maneuver for 30 min plus octreotide (PM30-OCT), Group C: Pringle maneuver for 60 min plus octreotide (PM60-OCT) and Group D: Pringle maneuver for 30 min plus 0.9 % saline solution (PM30-SS), Pringle maneuver for 60 min plus 0.9 % saline solution (PM60-SS, Group E).


METHODS
Blood samples for the evaluation of both amylase and lipase levels were taken via the portal vein. Levels of glutathione, glutathione reductase, catalase, myeloperoxidase, nitric oxide, xanthine oxidase, malondialdehyde, tumour necrosis factor alpha (TNF-alpha), and interleukin-1 beta (IL-1 beta) were assessed in the excised pancreatic tissue.


RESULTS
In the octreotide-treated groups, the catalase level was significantly higher in Group B (PM30-OCT) as compared to Group C (PM60-OCT). Amylase, lipase, NO and IL-1 beta levels were higher in Group C (PM60-OCT). In the saline solution-treated groups, the catalase level was significantly higher in Group E (PM60-SS) than in Group D (PM30-SS) while nitric oxide and glutathione levels were found to be significantly lower in Group E (PM60-SS) than in Group D (PM30-SS). Comparison of those groups using the Pringle maneuver for 30 minutes, the octreotide-treated group (Group B, PM30-OCT) was found to have a higher degree of edematous change than the saline-treated group (Group D, PM30-SS). Among the treatment groups, TNF-alpha expression decreased with increasing occlusion time.


CONCLUSIONS
In this study, pancreatic damage and the duration of the Pringle maneuver are directly proportional to each other. Moreover, the administration of octreotide prior to the Pringle maneuver contributed to the pancreatic damage.
Unalp
Omer Vedat
OV
Department of General Surgery, Ege University School of Medicine, Izmir, Turkey.
Aydin
Unal
U
Yazici
Pinar
P
Nart
Deniz
D
Yenisey
Cigdem
C
Kavak
Tulay
T
Zeytunlu
Murat
M
Coker
Ahmet
A
D000681:Amylases / Q000097:blood; D000818:Animals; D002374:Catalase / Q000097:blood; D004487:Edema / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D005978:Glutathione / Q000097:blood; D005980:Glutathione Reductase / Q000097:blood; D006498:Hepatectomy / Q000009:adverse effects*; D053583:Interleukin-1beta / Q000378:metabolism; D008049:Lipase / Q000097:blood; D008297:Male; D015282:Octreotide / Q000494:pharmacology*; D010179:Pancreas / Q000187:drug effects / Q000201:enzymology / Q000473:pathology; D010182:Pancreatic Diseases / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D009195:Peroxidase / Q000097:blood; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D051381:Rats; D017208:Rats, Wistar; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D005765:Gastrointestinal Agents; D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha; D002374:Catalase; D009195:Peroxidase; D005980:Glutathione Reductase; D008049:Lipase; D000681:Amylases; D005978:Glutathione; D015282:Octreotide