title: The beneficial role of simultaneous splenectomy after extended hepatectomy: experimental study in pigs.
abstract: The role of hepatic hemodynamic modulation in the development of "small-for-size" syndrome (SFSS) after extended hepatectomy (EH) or living-donor liver transplantation is still controversial. We have designed an experimental study to investigate the effect of hemodynamic parameters of the liver circulation on the development of SFSS after EH in a porcine model.
  
  
  
  Eighteen pigs were randomly divided into two groups: group A has received EH (75%-80%) without splenectomy, and group B with EH and simultaneous splenectomy was carried out. Portal hemodynamics, liver function tests, histologic findings, injury and survival rates were compared between groups A and B.
  
  
  
  The 7-d survival rate in the splenectomy group was significantly improved compared with group A (88.9% versus 44.4%, P < 0.05). Portal vein pressure, portal vein flow, and liver function tests in the splenectomy group were significantly lower than in group A immediately after splenectomy and postoperatively until the day of sacrifice. Histologic findings in group A clearly illustrate severe inflammation, bridging necrosis, ischemic cholangitis, and severe congestion, while in group B there were less serious histologic changes.
  
  
  
  Our experimental study indicates that perioperative portal modulation can successfully prevent the manifestation of SFSS after EH. Therefore, by focusing on "flow" rather than on "size," researchers may understand better the pathophysiology of this syndrome.
authors.affiliation: First Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: antwnis_athanasiou@hotmail.com.
authors.forename: Antonios
authors.initials: A
authors.lastname: Athanasiou
authors.affiliation: Research Department, Experimental-Research Center ELPEN, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Papalois
authors.affiliation: First Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Kontos
authors.affiliation: First Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Griniatsos
authors.affiliation: First Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Liakopoulos
authors.affiliation: First Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Spartalis
authors.affiliation: Department of Pathology, Athens School of Medicine, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Agrogiannis
authors.affiliation: First Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Liakakos
authors.affiliation: First Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Pikoulis
mesh_terms: D000818:Animals; D006439:Hemodynamics; D006498:Hepatectomy / Q000009:adverse effects*; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008115:Liver Regeneration; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D011897:Random Allocation; D013156:Splenectomy; D013552:Swine
keywords: Animal model; Hepatectomy; Liver; Portal vein; Small-for-size syndrome