Pringle maneuver deteriorates gut barrier dysfunction induced by extended-liver radiofrequency ablation.
BACKGROUND
Large volume radiofrequency ablation (RFA) of the liver disrupts intestinal mucosa barrier with subsequent bacterial translocation.


OBJECTIVE
To investigate the effect of the Pringle maneuver applied concurrently with extended liver RFA on gut barrier integrity and bacterial translocation.


METHODS
Rats were subjected to 30% liver RFA following laparotomy (group RFA), RFA plus 30 min Pringle (group RFA + P), Pringle (group P) or sham operation (group S). Intestinal tissue specimens were excised for histopathological examination and assessment of mucosal morphometry, apoptotic activity, mitotic activity and oxidative state. Tissue specimens were collected from the mesenteric lymph nodes, non-ablated liver parenchyma, kidneys and lungs for bacterial culture. Blood samples were collected from the portal and systemic circulation for endotoxin level measurement.


RESULTS
In group RFA + P, intestinal histopathologic lesions, mucosal atrophy and crypt cell apoptosis were more prominent compared to group RFA. Mitotic activity was suppressed. Oxidative stress was equally induced in all experimental groups. The incidence of positive bacterial cultures, bacterial counts and endotoxin levels were higher in group RFA + P compared to the other groups.


CONCLUSIONS
The application of the Pringle maneuver concurrently with extended liver RFA aggravates gut barrier dysfunction with more aggressive translocation of endotoxins and intestinal bacteria.
Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece. pipsil@med.duth.gr
Petros
P
Ypsilantis
Maria
M
Lambropoulou
Anastasia
A
Grapsa
Ioannis
I
Tentes
Christina
C
Tsigalou
Maria
M
Panopoulou
Constantinos
C
Simopoulos
D000818:Animals; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D019446:Endotoxemia / Q000209:etiology; D007422:Intestines / Q000382:microbiology / Q000502:physiology*; D008099:Liver / Q000098:blood supply / Q000601:surgery*; D051381:Rats; D017208:Rats, Wistar; D015427:Reperfusion Injury