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Mohammad Golriz [1] and Maryam Ashrafi [1] and Elias Khajeh [1] and Ali Majlesara [1] and Christa Flechtenmacher [2] and Arianeb Mehrabi [1]

Academic Editor: Pierluigi Toniutto

1, Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany, uni-heidelberg.de

2, Department of General Pathology, University of Heidelberg, Heidelberg, Germany, uni-heidelberg.de

Received Jun 20, 2017; Accepted Aug 15, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Improved surgical techniques and perioperative care have increased the use of extended hepatectomy (EH) for the treatment of primary and metastatic liver lesions [1, 2]. The main limiting factor for EH in many patients is an insufficient remnant liver volume (RLV) [3]. Insufficient RLV causes posthepatectomy liver failure (PHLF), which increases postoperative morbidity and mortality [4]. The term small for size syndrome (SFSS) was first used to describe clinical manifestations of refractory ascites, coagulopathy, encephalopathy, and hyperbilirubinemia following partial liver transplantation [5, 6] and now includes PHLF with insufficient RLV [7, 8].

Human clinical trials to investigate SFSS are impractical because of the high morbidity and mortality rates and ethical concerns. Therefore, it is necessary to establish experimental models that are similar to the human condition. The anatomy and physiology of pigs are similar to humans [9, 10]; therefore porcine models of EH are well-suited to studying the pathophysiology and prediction of SFSS [11–16]. However, SFSS has not been prospectively evaluated following EH with regard to the clinical, laboratory, and histopathological findings. The aim of this study was to establish a porcine model of SFSS by analyzing the RLV following different degrees of liver resection, together with the clinical, laboratory, and histopathological outcomes.

2. Material and Methods

2.1. Study Design

Twenty-four female Landrace pigs with a body weight of 26 kg to 35 kg were used in this study. Animals were reared in the interdisciplinary biomedical research center (IBF) of the University of Heidelberg. The animals were weighed and blood samples were taken prior to surgery. Animals were allocated to one of three groups, with eight pigs in each group. In group A, 50% of the liver was resected (segments (II), (III), and (IV)). In...
 
 
 

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