title: Selective bowel decontamination improves the survival of 90% hepatectomy in rats.
abstract: BACKGROUND
  Clinically, hepatectomy is a clean procedure performed without routine antimicrobial prophylaxis, regardless of the extent of liver loss. Translocation of endotoxin has been recognized as a fatal complication leading to liver failure. After extended hepatectomy, the portal hypertension, mucosal damage, intrahepatic bile acid retention, inhibited enterokinesia, and so forth are likely to contribute to enhanced endotoxin absorption. The effect of selective bowel decontamination (SBD) on the prognosis of hepatectomy were investigated.
  
  
  METHODS
  We adopted rat models of partial hepatectomy (70%, PHx) and subtotal hepatectomy (90%, SHx), gentamicin or saline of the same amount was administrated preoperatively. Liver damage makers, portal and systemic lipopolysaccharide, mucosal damage, signaling pathways, liver regeneration, and bile canalicular networks reconstruction were investigated.
  
  
  RESULTS
  We found that SHx but not PHx resulted in significantly enhanced portal and systemic endotoxin. Inhibition of gastrointestinal gram-negative bacteria by gentamicin significantly reduced lipopolysaccharide levels and improved survival after SHx (56% with gentamicin, 24% with saline, P < 0.05). We also found SBD with gentamicin protected intestinal mucosa barrier, alleviated liver parenchymal damage, and promoted liver regeneration and bile canalicular networks reconstruction after extended liver resection.
  
  
  CONCLUSIONS
  We conclude that SBD is beneficial and necessary for extended hepatectomy.
authors.affiliation: Department & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Weizheng
authors.initials: W
authors.lastname: Ren
authors.affiliation: Department & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Aiqun
authors.initials: A
authors.lastname: Zhang
authors.affiliation: Department & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Chonghui
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chengdu, Sichuan, China.
authors.forename: Geng
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xinlan
authors.initials: X
authors.lastname: Ge
authors.affiliation: Department & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Pan
authors.affiliation: Department & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China. Electronic address: dongjh301@163.com.
authors.forename: Jia-hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000818:Animals; D003666:Decontamination; D004815:Epidermal Growth Factor / Q000502:physiology; D041981:Gastrointestinal Tract / Q000382:microbiology*; D005839:Gentamicins / Q000494:pharmacology; D006498:Hepatectomy / Q000401:mortality*; D007413:Intestinal Mucosa / Q000378:metabolism; D008070:Lipopolysaccharides / Q000378:metabolism; D008115:Liver Regeneration; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley
chemical_list: D005839:Gentamicins; D008070:Lipopolysaccharides; D004815:Epidermal Growth Factor
keywords: Endotoxin; Extended hepatectomy; Liver failure; Liver regeneration; Selective bowel decontamination