JOP. J Pancreas (Online) 2008; 10(3):284-291. JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 10, No. 3 - May 2009. [ISSN 1590-8577] 284 ORIGINAL ARTICLE The Effects of the Pringle Maneuver on the Pancreas: Can Octreotide Be Protective? Omer Vedat Unalp 1 , Unal Aydin 1 , Pinar Yazici 1 , Deniz Nart 2 , Cigdem Yenisey 3 , Tulay Kavak 3 , Murat Zeytunlu 1 , Ahmet Coker 1 Departments of 1 General Surgery and 2 Pathology, Ege University School of Medicine. Izmir, Turkey. 3 Department of Biochemistry, Adnan Menderes University School of Medicine. Aydin, Turkey ABSTRACT Objective The aim of this study was to evaluate the negative effects of the Pringle maneuver on pancreatic tissue with respect to the time of performing the maneuver. Moreover, the efficacy of octreotide therapy on pancreatic changes at the time of the Pringle maneuver was assessed. Animals Fifty male Wistar Albino rats were randomized into 5 groups. Design The groups were formed as follows: Group A: sham operation, Group B: Pringle maneuver for 30 min plus octreotide (PM30-OCT), Group C: Pringle maneuver for 60 min plus octreotide (PM60-OCT) and Group D: Pringle maneuver for 30 min plus 0.9 % saline solution (PM30-SS), Pringle maneuver for 60 min plus 0.9 % saline solution (PM60-SS, Group E). Main outcome measures Blood samples for the evaluation of both amylase and lipase levels were taken via the portal vein. Levels of glutathione, glutathione reductase, catalase, myeloperoxidase, nitric oxide, xanthine oxidase, malondialdehyde, tumour necrosis factor alpha (TNF-alpha), and interleukin-1 beta (IL-1 beta) were assessed in the excised pancreatic tissue. Results In the octreotide-treated groups, the catalase level was significantly higher in Group B (PM30-OCT) as compared to Group C (PM60-OCT). Amylase, lipase, NO and IL-1 beta levels were higher in Group C (PM60-OCT). In the saline solution-treated groups, the catalase level was significantly higher in Group E (PM60- SS) than in Group D (PM30-SS) while nitric oxide and glutathione levels were found to be significantly lower in Group E (PM60- SS) than in Group D (PM30-SS). Comparison of those groups using the Pringle maneuver for 30 minutes, the octreotide-treated group (Group B, PM30-OCT) was found to have a higher degree of edematous change than the saline-treated group (Group D, PM30-SS). Among the treatment groups, TNF-alpha expression decreased with increasing occlusion time. Conclusion In this study, pancreatic damage and the duration of the Pringle maneuver are directly proportional to each other. Moreover, the administration of octreotide prior to the Pringle maneuver contributed to the pancreatic damage. INTRODUCTION Acute pancreatitis may occur when factors involved in maintaining cellular homeostasis become unbalanced. The initiating event could be anything which injures the acinar cell and impairs the secretion of zymogen granules. The initiative factors include alcohol use, gallstones (causing approximately 80% of the cases), certain drugs, hyperlipidemia, ERCP and trauma. In up to 10% of cases, the cause of the pancreatitis remains unknown. Although the mechanisms destructive to pancreatic acinar cells are unknown, once a cellular injury pattern has been initiated, activated neutrophils exacerbate the problem by releasing superoxide (the respiratory burst) or proteolytic enzymes (cathepsins B, D, and G, collagenase and elastase). Finally, the release of cytokines, tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) by macrophages further mediates the local and/or systemic inflammatory responses. The pro-inflammatory cytokines, especially TNF and IL-1, play a critical role throughout the inflammatory period. In addition, acute pancreatitis can begin in the postoperative period of various types of surgery, including hepatic surgery [1, 2]. Some reports have addressed the hyperamylasemia and pancreatitis states present after hepatic surgery and linked those to chronic liver disease or a prolonged Pringle maneuver [1, 3]. It has also been proven that the Pringle maneuver can induce pancreatic venous congestion, hyperamylasemia and pancreatitis occurring secondarily to total clamping of the pancreatic venous system [4]. Nevertheless, how the pancreas responds to Received September 27 th , 2008 - Accepted March 16 th , 2009 Key words Animal Experimentation; Octreotide; Pancreas, Exocrine; Reperfusion Injury Acknowledgements Many thanks to Neda Amiri for their language assistance and helpful suggestions. We also thank Hatice Uluer for the help received in the statistical analysis of the data Correspondence Pinar Yazici Ege University School of Medicine, Department of General Surgery, Bornova, 35100, Izmir, Turkey Phone: +90-232.390.4020; Fax: +90-232.339.8838 E-mail: drpinaryazici@gmail.com Document URL http://www.joplink.net/prev/200905/13.html