[Understanding microcirculation deficits as the key to surgical planning in visceral surgery]

Abstract

It was the aim of our investigation to analyse microcirculatory disorders in order to optimize surgical decision-making intra- and perioperatively. Acute pancreatitis: The surgical principle to operate less and later is based on an improved ICU therapy. Using intravital microscopic quantification of pancreatic microcirculation it could be shown experimentally that in the early phase pancreatic necroses can be limited by improvement of pancreatic microcirculation. Hemodilution with dextran is superior to other regimens. Liver resection: The expansion of liver resections requires a reduction of ischaemia/reperfusion injury. Preconditioning of the liver, i.e. induction of short-term ischaemia prior to the main ischaemic period, results in an induction of protective mechanisms with increased tolerance to ischaemia. Liver transplantation: Liver microcirculation is a reliable parameter to predict graft quality intraoperatively and to monitor therapeutic approaches to ischaemia/reperfusion injury. With the analysis of microcirculatory disorders, a basic understanding for organ dysfunctions which lead to operation or are a result of surgical therapy can be gained.