Effect of partial hepatic section and omentoplasty on liver regeneration in the dog

rcbc Revista do Colégio Brasileiro de Cirurgiões Rev. Col. Bras. Cir. 0100-6991 1809-4546 Colégio Brasileiro de Cirurgiões Rio de Janeiro, RJ, Brazil The treatment and the morbimortality of hepatic trauma depend on the mechanism of injury and therapeutical approach that includes clinical follow-up, hepatorrhaphy, omentoplasty and prosthesis. The present paper assessed the hepatic recoverance after hepatorraphy and omentoplasty for treatment of liver incision in dog. Fifteen male mongrel dogs weighing between 7 and 12 kg, were used. Under sodium pentobarbital anesthesia ( 10mg/kg), the animals were submitted to a 2.5 cm deep and 8 cm long incision of the left liver lobe. The dogs were divided into three groups: 1- without repair (control); II- only hepatic suture; III- hepatic suture and omentoplasty. The two repairs were performed with 4-0 chromic catgut thread. All animals of group I died during the early postoperative period. The dogs of the groups II and III supported the 28 day-follow-up without problem. At the relaparotomy of the groups II and III multiple adhesions to an aparently normal liver were found. In the Group III, the omentum introduced in the hepatic wound was expulsed and remained attached to the liver capsule. At microscopy, it was observed discontinuity of vessels and biliary ducts at the leveI of liver scar; the intensity of inflammatory phenomenon was more important in the Group III. Little sections of omental tissue were found inside the parenchima. In conclusion the omentoplasty helped the liver suture, but did not prevent the interruption of vessels and bile ducts. ARTIGOS ORIGINAIS Efeito da secção hepática parcial e omentoplastia na regeneração hepática de cão Effect of partial hepatic section and omentoplasty on liver regeneration in the dog Andy Petroianu, TCBC.SPI; Vidal Trapiello NetoII; Carlos Roberto Messeder EsquerdoIII; Ricardo Hissachi NishimotoIV; Alfredo José Afonso BarbosaV IProfessor Titular do Departamento de Cirurgia da Faculdade de Medicina da UFMG; Docente Livre da Escola Paulista de Medicina-UNIFESP; Docente Livre da Faculdade de Medicina de Ribeirão Preto - UNIFESP; Doutor em Fisiologia e Farmacologia, Pesquisador I do CNPq IIMédico; Bolsista da FAPEMIG IIIAcadêmico da Faculdade de Medicina da UFMG; Bolsista do CNPQ IVAcadêmico da Faculdade de Medicina da UFMG VProfessor Titular do Departamento de Anatomia Patológica da Faculdade de Medicina da UFMG Endereço para correspondência RESUMO O tratamento e a morbimortalidade dos pacientes com traumatismo hepático dependem do mecanismo da lesão e da conduta terapêutica, que inclui acompanhamento clínico, hepatorrafia, omentoplastia e próteses. O presente trabalho avaliou a recuperação hepática em presença de omentoplastia após lesão cortante do fígado de cão. Foram utilizados 15 cães machos, mestiços, com peso variando entre 7kg e 12kg, anestesiados com pentabarbitúrico endovenoso e submetidos a corte longitudinal no lobo esquerdo, medindo 2,5cm de profundidade e 8cm de comprimento. Os animais foram divididos em três grupos (n=5): I- sem sutura (controle); II- sutura hepática apenas; III- sutura hepática com omentoplastia. O fio utilizado foi o categute cromado 4-0. Todos os animais do grupo I morreram no pós-operatório imediato, enquanto os cães dos grupos II e III suportaram bem os 28 dias de acompanhamento. À relaparotomia dos grupos II e III, encontraram-se múltiplas aderências ao fígado, que apresentou aspecto normal. No grupo III, o omento introduzido no ferimento hepático havia sido expulso e estava apenas aderido à cápsula do fígado macroscopicamente normal. À microscopia houve descontinuidade vascular e biliar entre os segmentos proximal e distal à hepatotomia. Os fenômenos cicatriciais foram mais exuberantes no grupo III, no qual se encontraram pequenas áreas do parênquima contendo fragmentos de omento. Concluindo, a omentoplastia facilitou o procedimento de reparo hepático, que, entretanto, não restabeleceu a contigüidade de vasos e ductos biliares. Unitermos: Fígado; Trauma hepático; Hepatorrafia; Omentoplastia; Regeneração hepática. ABSTRACT The treatment and the morbimortality of hepatic trauma depend on the mechanism of injury and therapeutical approach that includes clinical follow-up, hepatorrhaphy, omentoplasty and prosthesis. The present paper assessed the hepatic recoverance after hepatorraphy and omentoplasty for treatment of liver incision in dog. Fifteen male mongrel dogs weighing between 7 and 12 kg, were used. Under sodium pentobarbital anesthesia ( 10mg/kg), the animals were submitted to a 2.5 cm deep and 8 cm long incision of the left liver lobe. The dogs were divided into three groups: 1- without repair (control); II- only hepatic suture; III- hepatic suture and omentoplasty. The two repairs were performed with 4-0 chromic catgut thread. All animals of group I died during the early postoperative period. The dogs of the groups II and III supported the 28 day-follow-up without problem. At the relaparotomy of the groups II and III multiple adhesions to an aparently normal liver were found. In the Group III, the omentum introduced in the hepatic wound was expulsed and remained attached to the liver capsule. At microscopy, it was observed discontinuity of vessels and biliary ducts at the leveI of liver scar; the intensity of inflammatory phenomenon was more important in the Group III. Little sections of omental tissue were found inside the parenchima. 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