Effect of total hepatic vascular exclusion during liver resection on hepatic ultrastructure.

The aim of this investigation was to observe ultrastructural changes in the liver in response to warm ischemia during liver surgery. In 11 noncirrhotic patients, hepatic resection was performed under total vascular exclusion (TVE). The mean duration of warm ischemia was 28 minutes (range 16-48 minutes). Three specimens were taken from each patient: before clamping, at the end of TVE, and after reperfusion. Biopsy specimens were studied by light microscopy and by transmission electron microscopy (EM). At the end of the ischemic phase sinusoids were collapsed with resultant loss of normal hepatic architecture. Morphological changes to hepatocytes included focal chromatin condensation at the nuclear margins, distended nuclear envelope, and swelling of both mitochondria and endoplasmic reticulum. After reperfusion these changes reversed. The phenomenon of sinusoidal and hepatocellular recovery after TVE was seen in all the cases of this study, irrespective of age, sex, disease, type and severity of surgical intervention, and duration of TVE. It can be concluded that TVE over a period of 48 minutes has no irreversible deleterious effects on the ultrastructure of the noncirrhotic liver.