Elias Khajeh

Reply: Hepatic Hemodynamic Changes Following Stepwise Liver Resection (Golriz et al. J Gastrointest Surg (2016) 20:587-594)

1. Transhepatic flow variations and modulation following extended liver resection: Small for size and flow (SFSF) syndrome is one of themost challenging issues in extended hepatectomy. The role of transhepatic flow (THF) in this regard has been discussed many times during the last decades. –5 However, to our knowledge, there is no experimental big animal study and no clinical evaluation that shows the correlation of the remnant liver volume (RLV) and THF during a stepwise liver resection. Moreover, the available studies are either mainly focused on the partial liver transplantation or a modulation method. , 5–10

Meta-analysis of the prognostic role of perioperative platelet count in posthepatectomy liver failure and mortality: Perioperative platelet count in hepatectomy

Emerging evidence suggests that the perioperative platelet count (PLT) can predict posthepatectomy liver failure (PHLF). In this systematic review and meta‐analysis, the impact of perioperative PLT on PHLF and mortality was evaluated.

Response to: Comment on “Establishing a Porcine Model of Small for Size Syndrome following Liver Resection”

Transhepatic Flow (THF) Variations and Small for Size and Flow Syndrome (SFSF). The important role of THF variations in SFSF has been clarified by our group previously [3]. However, the mechanism and definition of SFSF should not be confused with one another. Variations in THF cause SFSF and can be considered a prerequisite factor for SFSF [4], but THF variations are not necessary for confirmation of the diagnosis. Moreover, we have previously showed the THF variations following extended liver resection [5, 6]. SFSF is diagnosed based on the clinical, laboratory, and, if possible, histopathological findings [7]. Hemodynamic variations during and after liver resection are measured to correlate these values with the diagnosis and to define prognostic cut-off values. Measuring hemodynamic variations could add extra information to our study but was not necessary to confirm the diagnosis.