Bacterial translocation during portal clamping for liver resection. A clinical study

M. Ferri, S. Gabriel, A. Gavelli, P. Franconeri and C. Huguet
Department of Surgery, Princess Grace Hospital, Monaco, Principality of Monaco.

OBJECTIVE: To determine the incidence and the clinical importance of gut-bacterial translocation after portal triad clamping for liver resection. DESIGN: Cohort study. SETTING: Multispecialty referral center. PATIENTS: Five cirrhotic and 10 noncirrhotic patients requiring liver resection. INTERVENTIONS: Elective liver resection under normothermic ischemic conditions (mean +/- SD duration, 40.2 +/- 13.1 minutes). Simultaneous sampling for qualitative culture of the systemic and portal blood, the upper gastrointestinal tract fluid, and a mesenteric lymph node (MLN) before and after liver resection. MAIN OUTCOME MEASURES: Positive culture rate, type of organism isolated, and septic complications rate. RESULTS: Before resection, blood cultures and MLNs were sterile in all but 1 patient; this culture-positive patient had had a recent colon resection for occlusive carcinoma and was excluded from further analysis. After resection, systemic and portal blood cultures were sterile in all cases. Conversely, the MNLs were culture positive in 6 (43%) of 14 patients. Coagulase-negative staphylococci were the most common isolates. A weak correlation was observed between the organisms isolated from the MLNs and those simultaneously present in the upper gastrointestinal tract fluid. There was no relationship between bacterial translocation and the outcome as patients with culture-positive MLNs showed no evidence of intraperitoneal septic complications and the only patient with a septic complication (a subphrenic abscess) had negative cultures after resection. CONCLUSION: A significant bacterial translocation in the MLNs occurs after portal triad clamping and liver resection, although not clinically relevant.