title: Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits.
abstract: BACKGROUND
  The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle's maneuver), continuous prolonged clamping results in liver ischemia.
  
  
  OBJECTIVE
  The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models.
  
  
  METHODS
  In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers.
  
  
  RESULTS
  There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation.
  
  
  CONCLUSIONS
  Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.
authors: Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Mohsen
authors: M
authors: Kolahdoozan
authors: Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Akbar
authors: A
authors: Behdad
authors: Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Mehrdad
authors: M
authors: Hosseinpour
authors: Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran.
authors: Samin
authors: S
authors: Behdad
authors: Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Mohammad Taghi
authors: MT
authors: Rezaei
keywords: Ischemia; Liver; Pringle’s Maneuver