Effects of a Pringle maneuver on jejunal mucosal oxygenation and blood flow in a porcine model

The Pringle maneuver is routinely used during hepatic surgery to reduce blood loss. However, its hemodynamic effects on extrahepatic organs—especially the gut—remain poorly understood. This study investigates the impact of 20- and 40-minute continuous Pringle maneuver on jejunal mucosal oxygenation and microcirculatory blood flow in a porcine model. Twenty-three anesthetized pigs were randomized into three groups: 20-minute Pringle maneuver (A, n = 7), 40-minute Pringle maneuver (B, n = 7), and control (C, n = 9). Systemic hemodynamics, mesenteric and portal blood flow, mucosal tissue oxygen tension (PO₂muc), mucosal hemoglobin oxygen saturation (HbO₂muc), and jejunal microvascular blood flow were measured at baseline, during Pringle maneuver (groups A and B), and at multiple time points up to 100 min after reperfusion. Intestinal acid-base status and oxygen transport variables were also analyzed. Following Pringle maneuver, systemic hemodynamic instability and hyperlactatemia were more pronounced and sustained in group B. Although mesenteric and portal blood flow normalized post-reperfusion, PO₂muc and HbO₂muc remained significantly reduced in both intervention groups compared to controls. This impairment was significantly greater and more persistent in the 40-minute group. Microvascular flow partially recovered after Pringle maneuver, but mucosal oxygenation did not, indicating a dissociation between perfusion and oxygen delivery/utilization. Continuous Pringle maneuver induces duration-dependent impairments in jejunal mucosal oxygenation, despite recovery of macro- and microcirculatory blood flow. These findings highlight the predominance of reperfusion injury over ischemic hypoperfusion in splanchnic tissues with a dissociation between flow and oxygenation and suggest that prolonged Pringle maneuver may compromise intestinal barrier integrity and promote systemic inflammation.