Background:
Liver cirrhosis is a relevant comorbidity with increasing prevalence. Postoperative decompensation and development of complications in patients with
cirrhosis remains a frequent clinical problem. Surgery has been discussed as a precipitating event for decompensation and complications of
cirrhosis, but the underlying pathomechanisms are still obscure. The aim of this study was to analyze the role of abdominal extrahepatic surgery in
cirrhosis on portal pressure and
fibrosis in a preclinical model. Methods: Compensated
liver cirrhosis was induced using tetrachlormethane (CCL4) inhalation and bile duct
ligation (BDL) models in rats, non-cirrhotic
portal hypertension by partial portal vein
ligation (PPVL). Intestinal manipulation (IM) as a model of extrahepatic abdominal surgery was performed. 2 and 7 days after IM, portal pressure was measured in-vivo.
Hydroxyproline measurements, Sirius Red staining and qPCR measurements of the liver were performed for evaluation of
fibrosis development and hepatic
inflammation. Laboratory parameters of liver function in serum were analyzed. Results: Portal pressure was significantly elevated 2 and 7 days after IM in both models of
cirrhosis. In the non-cirrhotic model the trend was the same, while not statistically significant. In both cirrhotic models, IM shows strong effects of decompensation, with significant
weight loss, elevation of liver
enzymes and
hypoalbuminemia. 7 days after IM in the BDL group, Sirius red staining and
hydroxyproline levels showed significant progression of
fibrosis and significantly elevated
mRNA levels of hepatic
inflammation compared to the respective control group. A progression of
fibrosis was not observed in the CCL4 model. Conclusion: In animal models of
cirrhosis with continuous liver injury (BDL), IM increases portal pressure, and development of
fibrosis. Perioperative portal pressure and hence
inflammation processes may be therapeutic targets to prevent post-operative decompensation in
cirrhosis.