• Antonios Athanasiou, Apostolos Papalois, Michael Kontos, John Griniatsos, Dimitrios Liakopoulos, Eleftherios Spartalis, George Agrogiannis, Theodoros Liakakos, and Emmanouil Pikoulis.
• First Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: antwnis_athanasiou@hotmail.com.
• J. Surg. Res. 2017 Feb 1; 208: 121-131.

BackgroundThe role of hepatic hemodynamic modulation in the development of "small-for-size" syndrome (SFSS) after extended hepatectomy (EH) or living-donor liver transplantation is still controversial. We have designed an experimental study to investigate the effect of hemodynamic parameters of the liver circulation on the development of SFSS after EH in a porcine model.MethodsEighteen pigs were randomly divided into two groups: group A has received EH (75%-80%) without splenectomy, and group B with EH and simultaneous splenectomy was carried out. Portal hemodynamics, liver function tests, histologic findings, injury and survival rates were compared between groups A and B.ResultsThe 7-d survival rate in the splenectomy group was significantly improved compared with group A (88.9% versus 44.4%, P < 0.05). Portal vein pressure, portal vein flow, and liver function tests in the splenectomy group were significantly lower than in group A immediately after splenectomy and postoperatively until the day of sacrifice. Histologic findings in group A clearly illustrate severe inflammation, bridging necrosis, ischemic cholangitis, and severe congestion, while in group B there were less serious histologic changes.ConclusionsOur experimental study indicates that perioperative portal modulation can successfully prevent the manifestation of SFSS after EH. Therefore, by focusing on "flow" rather than on "size," researchers may understand better the pathophysiology of this syndrome.Copyright © 2016 Elsevier Inc. All rights reserved.

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