Portal flow modulation by splenic artery ligation to prevent posthepatectomy liver failure: A randomized controlled trial
Abstract
Background Posthepatectomy liver failure is a serious clinical issue with high mortality, similar in pathophysiology to small-for-size syndrome seen in liver transplantation. This study evaluates the efficacy of splenic artery ligation in reducing posthepatectomy liver failure in patients with portal venous pressure >15 mm Hg after hepatectomy. Methods This single-center, randomized controlled trial was conducted from May 2019 to November 2023. Eligible participants were patients scheduled for open hepatectomy for any indication. Patients with a portal venous pressure >15 mm Hg were randomized into splenic artery ligation and control groups in a 1:1 ratio. The primary outcomes were posthepatectomy liver failure grades B and C (International Study group of Liver Surgery criteria), and secondary outcomes included 90-day mortality, comprehensive complication index, and ascites volume. Results The study was terminated early, before reaching the calculated sample size, because the primary outcome in the intervention group demonstrated statistically significant results. Of the 92 patients, 36 had elevated portal venous pressure, which was associated with greater rates of posthepatectomy liver failure grades B and C (41.67% vs 3.57%, P Conclusion Splenic artery ligation is effective in reducing posthepatectomy liver failure in patients with high portal venous pressure after hepatectomy.
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Junrungsee et al demonstrated that modulating portal flow via splenic artery ligation reduced post-hepatectomy liver failure from 22% to 7%.
“Similarly, Junrungsee et al[23] demonstrated that modulating portal flow via splenic artery ligation reduced post-hepatectomy liver failure from 22% to 7%.”
From Liver regeneration after partial hepatectomy: Triggers and mechanisms (2025) · cites this paper as [23]
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- Authors
- Junrungsee, S., Vipudhamorn, W., Lapisatepun, W., Thepbunchonchai, A., Chotirosniramit, A., Lapisatepun, W., & Ko-iam, W.
- Affiliations
- Chiang Mai University (TH)
- Corresponding author
- Junrungsee, Sunhawit
- ORCID
- Venue
- Surgery
- Publisher
- Elsevier BV
- Published
- 2025-09
- Volume
- 185
- Pages
- 109351
- ISSN
- 0039-6060 (ISSN-L)
- OpenAlex
- W4409309549
- Cited by
- 13
- References
- 49
- Citations by year
- 2026: 6 · 2025: 7
- FWCI
- 12.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Chiang Mai University Faculty of Medicine
- Topics
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Keywords
- splenic artery ligation, post-hepatectomy liver failure, hepatectomy, portal pressure, portal hypertension, ascites, Comprehensive Complication Index, small-for-size syndrome
- MeSH terms
- Adult, Aged, Female, Hepatectomy, Humans, Ligation, Male, Middle Aged, Portal Vein, Postoperative Complications, Splenic Artery, Treatment Outcome, Portal Pressure, Liver Failure
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