Primary Malignant Fibrous Histiocytoma of the Spleen: Recurrence Eight Years after Splenectomy – Report of a Case and Literature Review

Primary intraabdominal malignant mesenchymal tumors are very rare. There are just few cases of intraabdominal visceral malignant fibrous histiocytoma in the literature. We report a case of primary malignant fibrous histiocytoma of the spleen in a 57-year-old man, with a recurrence eight years after the splenectomy. After the initial surgery the patient was without complaints, and refused to receive chemotherapy or radiotherapy. Eight years after the surgery the patient reported due to general weakness and malaise when the diagnosis of disease relapse was established. Radical surgery was performed although the tumor involved large curvature of the stomach, left crus of the diaphragm, splenic flexure of the colon and tail of pancreas. Four months after the surgery patient died. To the best of our knowledge, to date, only 18 cases have been reported in the literature, describing malignant fibrous histiocytoma of the spleen

Laparoskopska parcijalna pericistektomija ehinokokne ciste slezene – prikaz bolesnice [Laparoscopic partial pericystectomy of splenic hydatid cyst - a case report]

Echinococcal cyst of the spleen is usually a result of infection with the parasite Echinococcus granulosus. The spleen is the third most frequent localization of echinococcus after liver and lungs. Partial laparoscopic pericystectomy can be done without the loss of blood and scattering of scolexes with spleen preservation and conservation of its immune function. We present the patient with a large (1 8 x 16 x 12 cm) echinococcal cyst of the spleen that compressed the surrounding organs (stomach, transverse colon, pancreas and left kidney), and prevented normal passage causing vomiting after every meal. In this patient, PAIR procedure (puncture, aspiration, injection, reaspiration) and conservative treatment was attempted on several occasions without success. Finally, laparoscopic partial pericystectomy was performed, evacuating the contents of the cyst. The surgery lasted 120 minutes. Postoperatively the patient was without complications. Hospitalization lasted five days. Six months later, the patient is without problems. These echinococcus cysts of the spleen cannot be solved using PAIR technique and conservative treatment. Laparoscopic partial pericystectomy is a better solution than open surgery due to less trauma to the patient, especially in elderly people

LAPAROSCOPIC PARTIAL PERICYSTECTOMY OF SPLENIC HYDATID CYST – A CASE REPORT

Ehinokokna cista slezene redovito je posljedica infekcije parazitom Echinococcus granulosus. Slezena je treća najčešća lokalizacija ehinokoka, nakon jetre i pluća. Parcijalna laparoskopska pericistektomija može se učiniti bez gubitka krvi i rasapa skoleksa s prezervacijom slezene i očuvanjem njezine imunosne funkcije. Prikazana je pacijentica s velikom (18 × 16 × 12 cm) ehinokoknom cistom slezene koja je pritiskala okolne organe (želudac, poprečni kolon, pankreas i lijevi bubreg), onemogućavajući normalnu pasažu i izazivajući povraćanje nakon svakog obroka. Kod bolesnice su u nekoliko navrata neuspješno pokušani postupak PAIR (punkcija, aspiracija, injekcija, reaspiracija) i konzervativno liječenje te je naposljetku učinjena laparoskopska parcijalna pericistektomija s evakuacijom sadržaja ciste. Zahvat je trajao 120 minuta. Postoperacijski tijek protekao je bez komplikacija. Hospitalizacija je trajala 5 dana. Šest mjeseci kasnije bolesnica je bez tegoba. Ovakve ehinokokne ciste slezene nije moguće ukloniti tehnikom PAIR i konzervativnim liječenjem. Laparoskopska parcijalna pericistektomija bolje je rješenje od otvorene operacije zbog manje traume za organizam, osobito kod starijih ljudi.Echinococcal cyst of the spleen is usually a result of infection with the parasite Echinococcus granulosus. The spleen is the third most frequent localization of echinococcus after liver and lungs. Partial laparoscopic pericystectomy can be done without the loss of blood and scattering of scolexes with spleen preservation and conservation of its immune function. We present the patient with a large (18×16×12 cm) echinococcal cyst of the spleen that compressed the surrounding organs (stomach, transverse colon, pancreas and left kidney), and prevented normal passage causing vomiting after every meal. In this patient, PAIR procedure (puncture, aspiration, injection, reaspiration) and conservative treatment was ­attempted on several occasions without success. Finally, laparoscopic partial pericystectomy was performed, evacuating the contents of the cyst. The surgery lasted 120 minutes. Postoperatively the patient was without complications. Hospi­talization lasted five days. Six months later, the patient is without problems. These echinococcus cysts of the spleen cannot be solved using PAIR technique and conservative treatment. Laparoscopic partial pericystectomy is a better solution than open surgery due to less trauma to the patient, especially in elderly people

Comparison of hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning of the liver vs local ischemic preconditioning of the liver during human liver resections

AIM: To compare and evaluate the hepatoprotective effect of remote ischemic preconditioning (RIPC) with local ischemic preconditioning (LIPC) of the liver during human liver resections. ----- METHODS: A prospective, single-centre, randomised control trial was conducted in the Clinical Hospital "***" from April 2017 to January 2018. A total of 60 patients, who underwent liver resection due to colorectal cancer liver metastasis, were randomised to one of three study arms: 1) a RIPC group, 2) an LIPC group and 3) a control group (CG) in which no ischemic preconditioning was done before liver resection. The hepatoprotective effect was evaluated by comparing serum transaminase levels, bilirubin levels, albumin, and protein levels, coagulograms and through pathohistological analysis. The trial was registered on ClinicalTrials.gov (NCT****). ----- RESULTS: Significant differences were found in serum levels of liver transaminases and bilirubin levels between the groups, the highest level in the CG and the lowest level in the LIPC group. Levels of cholinesterase were also significantly higher in the LIPC group. Pathohistological findings graded by the Rodriguez score showed favourable changes in the LIPC and RIPC groups versus the CG. ----- CONCLUSION: Strong evidence supports the hepatoprotective effect of RIPC and LIPC preconditioning from an ischemia-reperfusion injury of the liver. Better synthetic liver function preservation in these two groups supports this conclusion

LAPAROSCOPIC PARTIAL PERICYSTECTOMY OF SPLENIC HYDATID CYST – A CASE REPORT

Ehinokokna cista slezene redovito je posljedica infekcije parazitom Echinococcus granulosus. Slezena je treća najčešća lokalizacija ehinokoka, nakon jetre i pluća. Parcijalna laparoskopska pericistektomija može se učiniti bez gubitka krvi i rasapa skoleksa s prezervacijom slezene i očuvanjem njezine imunosne funkcije. Prikazana je pacijentica s velikom (18 × 16 × 12 cm) ehinokoknom cistom slezene koja je pritiskala okolne organe (želudac, poprečni kolon, pankreas i lijevi bubreg), onemogućavajući normalnu pasažu i izazivajući povraćanje nakon svakog obroka. Kod bolesnice su u nekoliko navrata neuspješno pokušani postupak PAIR (punkcija, aspiracija, injekcija, reaspiracija) i konzervativno liječenje te je naposljetku učinjena laparoskopska parcijalna pericistektomija s evakuacijom sadržaja ciste. Zahvat je trajao 120 minuta. Postoperacijski tijek protekao je bez komplikacija. Hospitalizacija je trajala 5 dana. Šest mjeseci kasnije bolesnica je bez tegoba. Ovakve ehinokokne ciste slezene nije moguće ukloniti tehnikom PAIR i konzervativnim liječenjem. Laparoskopska parcijalna pericistektomija bolje je rješenje od otvorene operacije zbog manje traume za organizam, osobito kod starijih ljudi.Echinococcal cyst of the spleen is usually a result of infection with the parasite Echinococcus granulosus. The spleen is the third most frequent localization of echinococcus after liver and lungs. Partial laparoscopic pericystectomy can be done without the loss of blood and scattering of scolexes with spleen preservation and conservation of its immune function. We present the patient with a large (18×16×12 cm) echinococcal cyst of the spleen that compressed the surrounding organs (stomach, transverse colon, pancreas and left kidney), and prevented normal passage causing vomiting after every meal. In this patient, PAIR procedure (puncture, aspiration, injection, reaspiration) and conservative treatment was ­attempted on several occasions without success. Finally, laparoscopic partial pericystectomy was performed, evacuating the contents of the cyst. The surgery lasted 120 minutes. Postoperatively the patient was without complications. Hospi­talization lasted five days. Six months later, the patient is without problems. These echinococcus cysts of the spleen cannot be solved using PAIR technique and conservative treatment. Laparoscopic partial pericystectomy is a better solution than open surgery due to less trauma to the patient, especially in elderly people

Indeks ALBI kao prediktor preživljenja nakon resekcije hepatocelularnog karcinoma u bolesnika s kompenziranom cirozom jetre: usporedba s indeksima PALBI i MELD

The aim of the study was to explore predictive value of the ALBI, PALBI and MELD scores on survival in patients resected for hepatocellular carcinoma with compensated liver cirrhosis and no macrovascular infi ltration. In this retrospective study, longitudinal survival analysis was performed. We analyzed patient/tumor characteristics and MELD, ALBI and PALBI scores as liver function tests for predicting survival outcome. Survival was analyzed from the date of liver resection until death, liver transplantation, or end of follow-up. Patients were stratifi ed for age, cirrhosis etiology, presence of esophageal varices, hepatocellular carcinoma stage, microvascular invasion, histologic diff erentiation, and resection margins. We identifi ed 38 patients (alcoholic cirrhosis in 84.2% of patients) resected over an 8-year period. Median preoperative MELD score was 8, ALBI score -2.63, and PALBI score -2.38. During the follow-up period, 24 patients died. Estimated median survival time was 36 months. Microvascular invasion was observed in 33 patients. Higher ALBI score was associated with 23.1% higher relative risk of death. PALBI score was associated with 12.1% higher relative risk of death, whereas MELD score was not associated with the risk of death. In conclusion, ALBI score demonstrated signifi cant predictive capabilities for survival in patients with compensated cirrhosis resected for hepatocellular carcinoma.Cilj je bio istražiti prediktivnu vrijednost zbira ALBI, PALBI i MELD za preživljenje bolesnika s kompenziranom cirozom reseciranih zbog hepatocelularnog karcinoma bez makrovaskularne invazije. Provedena je retrospektivna longitudinalna analiza preživljenja. Testirane su karakteristike bolesnika/tumora kao i jetreni funkcijski testovi MELD, ALBI i PALBI za predviđanje preživljenja. Bolesnici su praćeni nakon resekcije jetre do smrti, transplantacije jetre odnosno do kraja vremena praćenja. Bolesnici su kategorizirani po dobi, etiologiji ciroze, prisutnosti varikoziteta jednjaka, stadiju karcinoma, mikrovaskularnoj invaziji, histološkom stadiju i resekcijskim rubovima. Identifi cirali smo 38 bolesnika (alkoholna ciroza kod 84,2% bolenika) reseciranih kroz razdoblje od 8 godina. Medijan prijeoperacijskog zbira MELD bio je 8, zbira ALBI -2,63 i zbira PALBI -2,38. Tijekom praćenja 24 bolesnika su umrla. Očekivani medijan preživljenja iznosio je 36 mjeseci. Mikrovaskularna invazija pronađena je u 33 bolesnika. Veći ALBI je bio povezan s 23,1%, a PALBI s 12,1% većim relativnim rizikom od smrtnog ishoda. MELD nije bio povezan sa smrtnim ishodom. Zbir ALBI je pokazao značajnu prediktivnu vrijednost preživljenja u skupini bolesnika s kompenziranom cirozom reseciranih zbog hepatocelularnog karcinoma

Bypassing major venous occlusion and duodenal lesions in rats, and therapy with the stable gastric pentadecapeptide BPC 157, L-NAME and L-arginine

AIM: To investigate whether duodenal lesions induced by major venous occlusions can be attenuated by BPC 157 regardless nitric oxide (NO) system involvement. ----- METHODS: Male Wistar rats underwent superior anterior pancreaticoduodenal vein (SAPDV)-ligation and were treated with a bath at the ligated SAPDV site (BPC 157 10 μg, 10 ng/kg per 1 mL bath/rat; L-NAME 5 mg/kg per 1 mL bath/rat; L-arginine 100 mg/kg per 1 mL bath/rat, alone and/or together; or BPC 157 10 μg/kg instilled into the rat stomach, at 1 min ligation-time). We recorded the vessel presentation (filled/appearance or emptied/disappearance) between the 5 arcade vessels arising from the SAPDV on the ventral duodenum side, the inferior anterior pancreaticoduodenal vein (IAPDV) and superior mesenteric vein (SMV) as bypassing vascular pathway to document the duodenal lesions presentation; increased NO- and oxidative stress [malondialdehyde (MDA)]-levels in duodenum. ----- RESULTS: Unlike the severe course in the SAPDV-ligated controls, after BPC 157 application, the rats exhibited strong attenuation of the mucosal lesions and serosal congestion, improved vessel presentation, increased interconnections, increased branching by more than 60% from the initial value, the IAPDV and SMV were not congested. Interestingly, after 5 min and 30 min of L-NAME and L-arginine treatment alone, decreased mucosal and serosal duodenal lesions were observed; their effect was worsened at 24 h, and no effect on the collateral vessels and branching was seen. Together, L-NAME+L-arginine antagonized each other's response, and thus, there was an NO-related effect. With BPC 157, all SAPDV-ligated rats receiving L-NAME and/or L-arginine appeared similar to the rats treated with BPC 157 alone. Also, BPC 157 in SAPDV-ligated rats normalized levels of NO and MDA, two oxidative stress markers, in duodenal tissues. ----- CONCLUSION: BPC 157, rapidly bypassing occlusion, rescued the original duodenal flow through IAPDV to SMV flow, an effect related to the NO system and reduction of free radical formation

Comparison of hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning of the liver vs local ischemic preconditioning of the liver during human liver resections

Cilj: Je bio procijeniti učinak udaljenog ishemijsko prekondicioniranja (UIPC) u sprečavanju nastanaka ishemijsko-reperfuzijske ozlijede (IR) na jetrenom ostatku nakon resekcija iste te taj učinak usporediti s učinkom lokalnog ishemijskog prekondicioniranja jetre (LIPC). Metode: Randomizirano kontrolirano istraživanje je provedeno na Odijelu hepatobilijarne kirurgije Kliničke bolnice Dubrava u Zagrebu od siječnja 2016. godine do lipnja 2018. godine. U istraživanje je uključeno 90 bolesnika operiranih poradi metastaza kolorektalnog karcinoma u jetru. Bolesnici su randomizirani u tri skupine: 1) skupina UIPC, 2) skupina LIPC te 3) kontrolna skupina (KS) kod koje nije provođen nikakav oblik prekondicioniranja jetre prije resekcije. Učinak zaštite jetre od IR ozlijede određenom tehnikom prekondicioniranja se procjenjivao uspoređujući rezultate mjerenja vrijednosti: aspartat aminotransferaze – AST, alanin aminotransferaze - ALT, gamaglutamil aminotransferaze – GGT, aktivnog parcijalnog tromboplastinskog vremena – APTV, protrombinskog vremena - PV, albumina – Alb, serumskih proteina – SP, acetilkolinesteraze – Acth, bilirubina – Bil. Vrijednosti su se mjerile predoperativno, prvog , trećeg i sedmog postoperativnog dana. Također su se intraoperacijski, nakon prekondicioniranja dopler UZV - om mjerile brzine protoka kroz hepatalnu arteriju i portalnu venu. Postoperativno su se preparati patohistološki analizirali po Rodriguez. Istraživanje je registrirano u bazi podataka ClinicalTrials.gov (NCT03130920). Rezultati: Značajna razlika je utvrđena u serumskim vrijednostima jetrenih transaminaza i bilirubina između skupina, najviše vrijednosti su zabilježene u KS a najmanje u LIPC skupini. Vrijednosti Acth su također pokazale razlike između skupina, najviše su bile u LIPC skupini. Patohistološko vrednovanje preparata po Rodriguezu je pokazalo manju razinu nekroze kod LIPC i UIPC u odnosu na KS. Brzine protoka zabilježene dopler UZV-om su pokazale porast protoka kroz hepatalnu arteriju nakon LIPC. Zaključak: Bolja očuvanost sintetske funkcije jetre nakon resekcija iste u LIPC skupini i UIPC skupini ukazuje na postojanje zaštitnog učinka ove dvije metode prekondicioniranja od IR ozlijede jetre.Aim: To compare and evaluate the hepatoprotective effect of remote ischemic preconditioning (RIPC) with local ischemic preconditioning (LIPC) of the liver during human liver resections. Methods: A prospective, single-center, randomized control trial was conducted in the Clinical Hospital “Dubrava” from January 2016 to June 2018. A total of 90 patients, who underwent liver resection due to colorectal cancer liver metastasis, were randomised to one of three study arms: 1) a RIPC group, 2) an LIPC group and 3) a control group (CG) in which no ischemic preconditioning was done before liver resection. The hepatoprotective effect was evaluated by comparing serum transaminase levels, bilirubin levels, albumin, and protein levels, coagulograms and through pathohistological analysis. The trial was registered on ClinicalTrials.gov (NCT03130920). Results: Significant differences were found in serum levels of liver transaminases and bilirubin levels between the groups, the highest level in the CG and the lowest level in the LIPC group. Levels of cholinesterase were also significantly higher in the LIPC group. Pathohistological findings graded by the Rodriguez score showed favorable changes in the LIPC and RIPC groups versus the CG. Conclusion: Strong evidence supports the hepatoprotective effect of RIPC and LIPC preconditioning from an ischemia-reperfusion injury of the liver. Better synthetic liver function preservation in these two groups supports this conclusion

Comparison of hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning of the liver vs local ischemic preconditioning of the liver during human liver resections

Cilj: Je bio procijeniti učinak udaljenog ishemijsko prekondicioniranja (UIPC) u sprečavanju nastanaka ishemijsko-reperfuzijske ozlijede (IR) na jetrenom ostatku nakon resekcija iste te taj učinak usporediti s učinkom lokalnog ishemijskog prekondicioniranja jetre (LIPC). Metode: Randomizirano kontrolirano istraživanje je provedeno na Odijelu hepatobilijarne kirurgije Kliničke bolnice Dubrava u Zagrebu od siječnja 2016. godine do lipnja 2018. godine. U istraživanje je uključeno 90 bolesnika operiranih poradi metastaza kolorektalnog karcinoma u jetru. Bolesnici su randomizirani u tri skupine: 1) skupina UIPC, 2) skupina LIPC te 3) kontrolna skupina (KS) kod koje nije provođen nikakav oblik prekondicioniranja jetre prije resekcije. Učinak zaštite jetre od IR ozlijede određenom tehnikom prekondicioniranja se procjenjivao uspoređujući rezultate mjerenja vrijednosti: aspartat aminotransferaze – AST, alanin aminotransferaze - ALT, gamaglutamil aminotransferaze – GGT, aktivnog parcijalnog tromboplastinskog vremena – APTV, protrombinskog vremena - PV, albumina – Alb, serumskih proteina – SP, acetilkolinesteraze – Acth, bilirubina – Bil. Vrijednosti su se mjerile predoperativno, prvog , trećeg i sedmog postoperativnog dana. Također su se intraoperacijski, nakon prekondicioniranja dopler UZV - om mjerile brzine protoka kroz hepatalnu arteriju i portalnu venu. Postoperativno su se preparati patohistološki analizirali po Rodriguez. Istraživanje je registrirano u bazi podataka ClinicalTrials.gov (NCT03130920). Rezultati: Značajna razlika je utvrđena u serumskim vrijednostima jetrenih transaminaza i bilirubina između skupina, najviše vrijednosti su zabilježene u KS a najmanje u LIPC skupini. Vrijednosti Acth su također pokazale razlike između skupina, najviše su bile u LIPC skupini. Patohistološko vrednovanje preparata po Rodriguezu je pokazalo manju razinu nekroze kod LIPC i UIPC u odnosu na KS. Brzine protoka zabilježene dopler UZV-om su pokazale porast protoka kroz hepatalnu arteriju nakon LIPC. Zaključak: Bolja očuvanost sintetske funkcije jetre nakon resekcija iste u LIPC skupini i UIPC skupini ukazuje na postojanje zaštitnog učinka ove dvije metode prekondicioniranja od IR ozlijede jetre.Aim: To compare and evaluate the hepatoprotective effect of remote ischemic preconditioning (RIPC) with local ischemic preconditioning (LIPC) of the liver during human liver resections. Methods: A prospective, single-center, randomized control trial was conducted in the Clinical Hospital “Dubrava” from January 2016 to June 2018. A total of 90 patients, who underwent liver resection due to colorectal cancer liver metastasis, were randomised to one of three study arms: 1) a RIPC group, 2) an LIPC group and 3) a control group (CG) in which no ischemic preconditioning was done before liver resection. The hepatoprotective effect was evaluated by comparing serum transaminase levels, bilirubin levels, albumin, and protein levels, coagulograms and through pathohistological analysis. The trial was registered on ClinicalTrials.gov (NCT03130920). Results: Significant differences were found in serum levels of liver transaminases and bilirubin levels between the groups, the highest level in the CG and the lowest level in the LIPC group. Levels of cholinesterase were also significantly higher in the LIPC group. Pathohistological findings graded by the Rodriguez score showed favorable changes in the LIPC and RIPC groups versus the CG. Conclusion: Strong evidence supports the hepatoprotective effect of RIPC and LIPC preconditioning from an ischemia-reperfusion injury of the liver. Better synthetic liver function preservation in these two groups supports this conclusion

Comparison of hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning of the liver vs local ischemic preconditioning of the liver during human liver resections

Cilj: Je bio procijeniti učinak udaljenog ishemijsko prekondicioniranja (UIPC) u sprečavanju nastanaka ishemijsko-reperfuzijske ozlijede (IR) na jetrenom ostatku nakon resekcija iste te taj učinak usporediti s učinkom lokalnog ishemijskog prekondicioniranja jetre (LIPC). Metode: Randomizirano kontrolirano istraživanje je provedeno na Odijelu hepatobilijarne kirurgije Kliničke bolnice Dubrava u Zagrebu od siječnja 2016. godine do lipnja 2018. godine. U istraživanje je uključeno 90 bolesnika operiranih poradi metastaza kolorektalnog karcinoma u jetru. Bolesnici su randomizirani u tri skupine: 1) skupina UIPC, 2) skupina LIPC te 3) kontrolna skupina (KS) kod koje nije provođen nikakav oblik prekondicioniranja jetre prije resekcije. Učinak zaštite jetre od IR ozlijede određenom tehnikom prekondicioniranja se procjenjivao uspoređujući rezultate mjerenja vrijednosti: aspartat aminotransferaze – AST, alanin aminotransferaze - ALT, gamaglutamil aminotransferaze – GGT, aktivnog parcijalnog tromboplastinskog vremena – APTV, protrombinskog vremena - PV, albumina – Alb, serumskih proteina – SP, acetilkolinesteraze – Acth, bilirubina – Bil. Vrijednosti su se mjerile predoperativno, prvog , trećeg i sedmog postoperativnog dana. Također su se intraoperacijski, nakon prekondicioniranja dopler UZV - om mjerile brzine protoka kroz hepatalnu arteriju i portalnu venu. Postoperativno su se preparati patohistološki analizirali po Rodriguez. Istraživanje je registrirano u bazi podataka ClinicalTrials.gov (NCT03130920). Rezultati: Značajna razlika je utvrđena u serumskim vrijednostima jetrenih transaminaza i bilirubina između skupina, najviše vrijednosti su zabilježene u KS a najmanje u LIPC skupini. Vrijednosti Acth su također pokazale razlike između skupina, najviše su bile u LIPC skupini. Patohistološko vrednovanje preparata po Rodriguezu je pokazalo manju razinu nekroze kod LIPC i UIPC u odnosu na KS. Brzine protoka zabilježene dopler UZV-om su pokazale porast protoka kroz hepatalnu arteriju nakon LIPC. Zaključak: Bolja očuvanost sintetske funkcije jetre nakon resekcija iste u LIPC skupini i UIPC skupini ukazuje na postojanje zaštitnog učinka ove dvije metode prekondicioniranja od IR ozlijede jetre.Aim: To compare and evaluate the hepatoprotective effect of remote ischemic preconditioning (RIPC) with local ischemic preconditioning (LIPC) of the liver during human liver resections. Methods: A prospective, single-center, randomized control trial was conducted in the Clinical Hospital “Dubrava” from January 2016 to June 2018. A total of 90 patients, who underwent liver resection due to colorectal cancer liver metastasis, were randomised to one of three study arms: 1) a RIPC group, 2) an LIPC group and 3) a control group (CG) in which no ischemic preconditioning was done before liver resection. The hepatoprotective effect was evaluated by comparing serum transaminase levels, bilirubin levels, albumin, and protein levels, coagulograms and through pathohistological analysis. The trial was registered on ClinicalTrials.gov (NCT03130920). Results: Significant differences were found in serum levels of liver transaminases and bilirubin levels between the groups, the highest level in the CG and the lowest level in the LIPC group. Levels of cholinesterase were also significantly higher in the LIPC group. Pathohistological findings graded by the Rodriguez score showed favorable changes in the LIPC and RIPC groups versus the CG. Conclusion: Strong evidence supports the hepatoprotective effect of RIPC and LIPC preconditioning from an ischemia-reperfusion injury of the liver. Better synthetic liver function preservation in these two groups supports this conclusion