Healing of the abdominal wall after parcial hepatectomy

Departamento de Cirurgia, Faculdade de Medicina, UFPR, PR, BR.
Revista do Colégio Brasileiro de Cirurgiões 04/2011; 38(2):127-32. DOI: 10.1590/S0100-69912011000200011
Source: PubMed

ABSTRACT To evaluate the wound healing of the abdominal wall incision in hepatectomized rats as for the concentration of collagen, inflammatory reaction and angiogenesis.
We used 48 rats randomly assigned to laparotomy with or without hepatectomy. The scars were studied in the 3rd, 7th and 14th postoperative days. We analyzed the density of collagen by the histochemical method and angiogenesis, by immunohistochemistry.
The analysis showed a lower total collagen concentration in skin and subcutaneous tissue in the abdominal scars of the experiment group (p3 = 0.011, p7 = 0.004 and p14 = 0.008). The density of collagen I was lower in the hepatectomy group, especially in the third day, in the skin, subcutaneous tissue (p = 0.038) and in the aponeurotic plane (p = 0.026). There was a lower concentration of collagen III in the two abdominal wall layers studied, although not statistically significant. The inflammatory response was similar at all times in both groups. It was found that angiogenesis was developed earlier in the control group (p3 = 0.005 and p7 = 0.012) and later in the experimental group (p14 = 0.048).
Hepatectomy leads to a delay in the healing process, interfering with collagen synthesis and angiogenesis.

Download full-text


Available from: Saulo J.A. Felizola, Sep 27, 2015
20 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Incisional hernia is an important complication of abdominal surgery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is best. Between March 1992 and February 1998, we performed a multicenter trial in which we randomly assigned to suture repair or mesh repair 200 patients who were scheduled to undergo repair of a primary hernia or a first recurrence of hernia at the site of a vertical midline incision of the abdomen of less than 6 cm in length or width. The patients were followed up by physical examination at 1, 6, 12, 18, 24, and 36 months. Recurrence rates and potential risk factors for recurrent incisional hernia were analyzed with the use of life-table methods. Among the 154 patients with primary hernias and the 27 patients with first-time recurrent hernias who were eligible for the study, 56 had recurrences during the follow-up period. The three-year cumulative rates of recurrence among patients who had suture repair and those who had mesh repair were 43 percent and 24 percent, respectively, with repair of a primary hernia (P=0.02; difference, 19 percentage points; 95 percent confidence interval, 3 to 35 percentage points). The recurrence rates were 58 percent and 20 percent with repair of a first recurrence of hernia (P=0.10; difference, 38 percentage points; 95 percent confidence interval, -1 to 78 percentage points). The risk factors for recurrence were suture repair, infection, prostatism (in men), and previous surgery for abdominal aortic aneurysm. The size of the hernia did not affect the rate of recurrence. Among patients with midline abdominal incisional hernias, mesh repair is superior to suture repair with regard to the recurrence of hernia, regardless of the size of the hernia.
    New England Journal of Medicine 09/2000; 343(6):392-8. DOI:10.1056/NEJM200008103430603 · 55.87 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abdominal wall wound failure remains a common surgical problem. The signals that activate normal fibroplastic repair versus regeneration pathways are unknown. Transforming growth factor beta levels rise during incisional healing but fall during hepatic regeneration. Changes in the injured host cytokine milieu may therefore differentially effect abdominal wall repair versus hepatic regeneration. Forty-eight rats were divided into four groups (n = 12). Groups 1-3 underwent sham celiotomy, 70% hepatectomy, or 80% enterectomy with anastamosis. Incisions from Group 4 were treated with either 1 microg of transforming growth factor beta(2) (TGF-beta(2)) or vehicle following hepatectomy. Isolated fascial and dermal incisions were harvested and tested for breaking strength on POD 7. Serum (TGF-beta(2)) and hepatocyte growth factor (HGF) levels were measured by ELISA. Recovery of incisional wound breaking strength was delayed following hepatectomy but not enterectomy (P<0.002). The inhibitory effect was observed in both the fascia and the dermis of the abdominal wall. TGF-beta(2) levels were depressed in hepatectomy animals on POD 7, while at the same time HGF levels were elevated. Exogenous TGF-beta(2) shifted the healing trajectory of deficient wounds back toward a control pattern. Abdominal wall fascial and dermal healing is delayed during hepatic regeneration. Elevated HGF and depressed TGF-beta(2) suggest a host mechanism that prioritizes hepatic parenchymal regeneration over fibroplastic repair (scar). Observations such as these are needed as therapeutic wound healing enters the clinical realm.
    Journal of Surgical Research 01/2001; 95(1):54-60. DOI:10.1006/jsre.2000.6038 · 1.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To elucidate hepatic collagen metabolism during liver regeneration after partial hepatectomy, we measured collagen content, collagen synthesis, and collagen-degrading enzyme activity in the remnant livers of rats 3, 5, 7, and 14 days after a partial hepatectomy of 68%. Hepatic collagen synthesis was significantly higher 3, 5, and 7 days after partial hepatectomy than it was in sham-operated control rats, but there was no such difference 14 days after surgery, the maximal hepatic collagen synthesis being observed 5 days after surgery. Although the collagen concentration in the remnant liver was similar to that in the control liver, the total collagen content of the remnant liver increased rapidly with liver regeneration until 7 days after partial hepatectomy. Hepatic collagenase activity was similar to the control; however, hepatic cathepsin B and cathepsin L activity and the intracellular degradation of newly synthesized collagen were markedly decreased 3, 5, and 7 days after partial hepatectomy compared with the controls. Hepatic collagen synthesis was significantly and inversely correlated with cathepsin L activity and with the intracellular degradation of newly synthesized collagen. These findings suggest that a combination of increased collagen synthesis and decreased intracellular collagen degradation contributes to the rapid supply of collagen that is observed during the early phase of liver regeneration.
    Hepatology 02/1995; 21(1):155-61. · 11.06 Impact Factor