Examination of pathological and biochemical findings of the damage caused by liver retraction during abdominal surgeries using an experimental model
Tuğba Acer Demir1
, Nihan Asuman Haberal Reyhan2, Derya Akaydın Aldemir3
1Department of Pediatric Surgery, Başkent University Faculty of Medicine, Ankara, Türkiye
2Department of Pathology, Başkent University Faculty of Medicine, Ankara, Türkiye
3Department of Biochemistry, Başkent University Faculty of Medicine, Ankara, Türkiye
Keywords: Abdominal, damage, hepatic, retraction, surgery.
Abstract
Objectives: This study aims to determine whether hepatic retraction during abdominal surgery causes damage to the hepatic tissue.
Materials and methods: Thirty Sprague-Dawley rats (mean weight: 227.3±13.2 g; range, 200 to 250 g) were allocated to the following four groups: (i) the control group; (ii) the retraction group, in which pressure was applied to the liver with Farabeuf’s retractor; (iii) the crush group, in which the liver was crushed with a bulldog clamp; and (iv) the deviation group, in which the liver was deviated cranially as creating angling to vascular structures. A liver tissue sample was taken for pathological and biochemical examination. Blood samples were collected for alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) measurements.
Results: The crush group showed a significant elevation of serum ALT, AST, and LDH levels, decreased tissue glutathione levels, increased malondialdehyde levels, severe sinusoidal dilatation/congestion, and necroinflammatory focus in the postoperative histopathological findings. The deviation group showed elevation in serum ALT levels, sinusoidal dilatation/congestion, and necroinflammatory focus postoperatively. According to the histopathological findings, although balloon cell degeneration, sinusoidal dilatation/congestion, and necroinflammatory focus were still observed on the 28th day in the retraction, crush, and deviation groups; however, the difference did not show statistical significance with the control group.
Conclusion: We found that the crush mechanism was more harmful to the liver tissue than the angling of vascular structures. We recommend keeping the hepatic retractions at minimum tension during the surgical procedures to protect the liver tissue, particularly in patients with limited liver function, such as cirrhotic patients and newborns with biliary atresia.
Citation: Acer Demir T, Haberal Reyhan NA, Akaydın Aldemir D. Examination of pathological and biochemical findings of the damage caused by liver retraction during abdominal surgeries using an experimental model. Turkish J Ped Surg 2025;39(3):130-140. doi: 10.62114/JTAPS.2025.177.