Okabayashi T, Maeda H, Sun ZL, Montgomery RA, Nishimori I, Hanazaki K. Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection. World J Gastroenterol 2009; 15(33): 4116-4121 [PMID: 19725143 DOI: 10.3748/wjg.15.4116]
Corresponding Author of This Article
Dr. Takehiro Okabayashi, Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan. tokabaya@kochi-u.ac.jp
Article-Type of This Article
Topic Highlight
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Sep 7, 2009; 15(33): 4116-4121 Published online Sep 7, 2009. doi: 10.3748/wjg.15.4116
Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection
Takehiro Okabayashi, Hiromichi Maeda, Zhao-Li Sun, Robert A Montgomery, Isao Nishimori, Kazuhiro Hanazaki
Takehiro Okabayashi, Hiromichi Maeda, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan
Takehiro Okabayashi, Department of Surgery, Johns Hopkins University School of Medicine, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan
Zhao-Li Sun, Robert A Montgomery, Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross 771E Baltimore, MD 21205, United States
Isao Nishimori, Department of Gastroenterology and Hepatology at Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan
Author contributions: Okabayashi T and Maeda H contributed equally to this work; Okabayashi T, Nishimori I and Hanazaki K designed the research; Okabayashi T and Maeda H performed the research; Okabayashi T, Maeda H, Sun ZL, Montgomery RA and Hanazaki K analyzed the data; Okabayashi T, Sun ZL, Montgomery RA, Nishimori I and Hanazaki K wrote the paper.
Correspondence to: Dr. Takehiro Okabayashi, Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan. tokabaya@kochi-u.ac.jp
Telephone: +81-88-8802370 Fax: +81-88-8802371
Received: April 23, 2009 Revised: July 6, 2009 Accepted: July 13, 2009 Published online: September 7, 2009
Abstract
Postoperative hyperglycemia is common in critically ill patients, even in those without a prior history of diabetes mellitus. It is well known that hyperglycemia induced by surgical stress often results in dysregulation of liver metabolism and immune function, impairing postoperative recovery. Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces the mortality and morbidity of critically ill patients. On the basis of these observations, several large randomized controlled studies were designed to evaluate the benefit of postoperative tight glycemic control with intensive insulin therapy. However, intensive insulin therapy carries the risk of hypoglycemia, which is linked to serious neurological events. Recently, we demonstrated that perioperative tight glycemic control in surgical patients could be achieved safely using a closed-loop glycemic control system and that this decreased both the incidence of infection at the site of the surgical incision, without the appearance of hypoglycemia, and actual hospital costs. Here, we review the benefits and requirements of perioperative intensive insulin therapy using a closed-loop artificial endocrine pancreas system in hepatectomized patients. This novel intensive insulin therapy is safe and effectively improves surgical outcome after hepatic resection.
