Ischaemic change of the human intestine after total portal occlusion during liver resection

This is a clinical study of the use of several monitoring techniques to eva luate the effect of total hepatic inflow occlusion on intestinal ischaemia during liver resection. A total of 8 patients was studied. Parameters measu red included intestinal oxygen extraction ratio, portal venous and arterial lactate levels and intestinal intramucosal pH (pHi), measured by an intral uminal tonometer. When venous outflow of the intestine was occluded, intest inal oxygen extraction ratio increased and portal venous lactate increased significantly, but arterial lactate did not increase significantly until af ter 60 minutes of occlusion. Intestinal pHi decreased significantly after 6 0 minutes. Following release of the occlusion, oxygen extraction and pHi re turned to normal in 7 out of 8 patients. The 1 patient who had a persistent decrease in pHi died postoperatively. These findings indicate that a marke d drop in pHi after total portal occlusion and persistent low pHi following the release of a portal occlusion are associated with the development of c omplications and mortality during liver resection.