Comparison of continuous versus intermittent ischaemia-reperfusion during liver resection in an experimental model.

It has been proposed that regular restoration of blood flow is beneficial during liver surgery with vascular isolation. The aim of this study was to compare intermittent versus continuous occlusion of blood flow to the resected liver, as measured by survival, liver function tests and histological examination. Male Wistar rats were allocated to have either sham operation, 80 per cent liver resection with 30 min continuous occlusion, or resection with intermittent occlusion (two 15-min periods of ischaemia separated by 5 min reperfusion). There was no significant difference in the survival rate, with 17 of 20 animals surviving in both ischaemia groups. There was a significantly higher serum alanine aminotransferase concentration on day 1 in animals receiving continuous occlusion, and significantly higher concentrations of bilirubin on days 8 and 23 and of serum alkaline phosphatase on day 23 in those having intermittent ischaemia (P < 0.001). There was a significantly greater loss and slower regaining of weight when occlusion was intermittent. Histological changes were significantly more pronounced at day 23 in animals undergoing intermittent ischaemia (P < 0.05), although these were in only one grading. Continuous and intermittent occlusion affected the components of liver function tests differently, with no advantage for one technique. These findings suggest that periodic release of inflow occlusion during liver surgery is not necessary.