Portal Venous Hemodynamic Changes After Hepatectomy

Portal Venous Hemodynamic Changes After Hepatectomy and the Incidence of Postoperative Ascites

The aim of this study is to investigate the pathophysiological mechanisms underlying the formation of posthepatectomy ascites with a focus on the significance of changes in portal venous hemodynamics after hepatic resection. By evaluation of other factors that may be involved in the formation of ascites this study may help to show to what extent the increase of portal venous pressure contributes to ascites formation. Detailed knowledge about pathogenetic factors concerning the formation of postoperative ascites might help preventing protracted hospital stay and further inconveniences to the patient.

Study Overview

• Status: Unknown
• Conditions: Hepatectomy; Ascites
• Intervention / Treatment: Procedure: Portal venous pressure; Procedure: Portal venous flow; Procedure: Hepatic artery flow

Detailed Description

The mechanisms underlying the development of large-volume ascites after hepatectomy remain poorly understood. While studies on animal models suggest an increase of portal venous pressure after hepatectomy that may in turn favor the transudation of fluid into the peritoneal cavity further factors may be critically involved in the postoperative formation of ascites. These factors may include a drop in serum protein levels (and colloid osmotic pressure), a transient impairment in renal function and a surgery-induced capillary leakage. However, a better knowledge of the pathophysiology represents the prerequisite for efficient treatment.

In the present study the impact of changes in hepatic hemodynamics after hepatectomy on development of ascites will be investigated. Enrolled patients will receive measurement of portal venous flow and pressure as well as hepatic artery flow before and after hepatic resection. Associations of changes in these parameters with development of postoperative ascites and further postoperative complications will be evaluated.

• Study Type: Observational
• Enrollment (Actual): 110

Contacts and Locations

Study Locations

• Germany
  • Heidelberg, Germany, 69120
    • Department of General, Visceral and Transplantation Surgery

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients treated at a University Hospital

Description

Inclusion Criteria:

• Patients scheduled for elective hepatic resection
• Age equal or greater than 18 years
• Informed consent

Exclusion Criteria:

• Evidence of ascites or hypalbuminemia preoperatively
• Renal insufficiency
• Expected lack of compliance
• Impaired mental state or language problems

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Major hepatic resection; Patients undergoing resection of > 2 liver segments	Procedure: Portal venous pressure; Portal venous pressure is measured by invasive means using an arterial canula; Procedure: Portal venous flow; Portal venous flow is measures using a noninvasive method (Doppler flow meter); Procedure: Hepatic artery flow; Hepatic artery flow will be measured using a noninvasive method (Doppler flow meter)
Minor hepatic resection; Patients undergoing resection of </= 2 liver segments	Procedure: Portal venous pressure; Portal venous pressure is measured by invasive means using an arterial canula; Procedure: Portal venous flow; Portal venous flow is measures using a noninvasive method (Doppler flow meter); Procedure: Hepatic artery flow; Hepatic artery flow will be measured using a noninvasive method (Doppler flow meter)
Control group; Patients undergoing exploratory laparotomy for hepatobiliary disease without resection (e.g. due to inoperable disease)	Procedure: Portal venous pressure; Portal venous pressure is measured by invasive means using an arterial canula; Procedure: Portal venous flow; Portal venous flow is measures using a noninvasive method (Doppler flow meter); Procedure: Hepatic artery flow; Hepatic artery flow will be measured using a noninvasive method (Doppler flow meter)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Postoperative ascites	7 days

Collaborators and Investigators

• Sponsor: Heidelberg University

Study record dates

Study Major Dates

• Study Start: February 1, 2010
• Primary Completion (Anticipated): December 1, 2010
• Study Completion (Anticipated): December 1, 2010

Study Registration Dates

• First Submitted: February 22, 2010
• First Submitted That Met QC Criteria: February 22, 2010
• First Posted (Estimate): February 23, 2010

Study Record Updates

• Last Update Posted (Estimate): February 23, 2010
• Last Update Submitted That Met QC Criteria: February 22, 2010
• Last Verified: February 1, 2010

More Information

Terms related to this study

• Keywords: Patients undergoing elective hepatic resection
• Additional Relevant MeSH Terms: Pathologic Processes; Ascites
• Other Study ID Numbers: NNR-4