Tissue injury related to liver surgery stimulates the release of stress hormones and proinflammatory cytokines to produce the necessary elements needed for healing. An exaggerated stress limits the livers capacity to regenerate by depleting its energy stores. This change in metabolism leads to an insulin resistant state in the patient and associated hyperglycaemia. Dextrose supplementation coupled with intravenous insulin given perioperatively affords superior surgical outcomes through preservation of liver glycogen and strict glycaemia control. The goal of this work was to investigate the benefits of a metabolic support protocol involving carbohydrate loading and insulin infusion provided by a hyperinsulinemic normoglycaemic clamp, for patients undergoing major hepatic resection.

Mazen Hassanain, MBBS, FRCS(C), PhD is an assistant professor of the King Saud University Department of Surgery. Completed his training in General Surgery followed by a fellowship in Solid Organ Transplant and Hepato-pancreato-billiary surgery at McGill University. Pursued his doctoral degree in Science in Experimental Surgery at McGill University