External drainage of the hepatic post hydatid remnant cavity.

BACKGROUND AND AIM: The surgical management of the hepatic post hydatid remnant cavity includes conservative and radical methods. External drainage of the remnant cavity (with or without cavity-minimizing) is a simple conservative method that can be safely performed, and can be associated with endoscopic papillo-sphincterectomy (EPS) in case of cysto-biliary fistula. METHODS: A retrospective study was performed on 112 patients operated in the Department of Surgery, "Caritas" Clinical Hospital, Bucharest between Jan 1997 and Feb 2007. Cavity was drained and the completely extraperitoneal approach for exteriorizing the drain was preferred, an original method conceived and put into practice by Prof. Dr. Burlui, using as pathway the round ligament, more precise the hepato-umbilical territory. RESULTS: The mean hospital stay was 12 days, and follow-up till complete recovery was performed by clinical, ultrasound, CT-scan and X-ray contrast on the drainage tube. The drainage of the remnant cavity was maintained a mean period of 55 days (ranging 20 to 80), in accordance with the X-ray contrast control on the drainage tube. The postoperative morbidity was acceptable (remnant cavity infection was registered in 11% of the cases). Neither reintervention, nor mortality was registered. CONCLUSIONS: the study shows that external drainage of the hepatic post hydatid remnant cavity can be applied in most of the parasite locations, especially for the central segments, with no hepatic parenchyma sacrifice, while total cavity fibrosis is achieved in a mean period of 55 days. This way we avoid a risky and laborious procedure (the anatomic or non-anatomic removal of a variable amount of normal hepatic tissue).

Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial.

BACKGROUND: Gastro-jejunal anastomotic leak and internal hernia can be life-threatening complications of laparoscopic Roux-en-Y gastric bypass (LRYGBP), ranging from 0.1-4.3% and from 0.8-4.5% respectively. The safety and efficacy of a fibrin glue (Tissucol) was assessed when placed around the anastomoses and over the mesenteric openings for prevention of anastomotic leaks and internal hernias after LRYGBP. METHODS: A prospective, randomized, multicenter, clinical trial commenced in January 2004. Patients with BMI 40-59 kg/m2, aged 21-60 years, undergoing LRYGBP, were randomized into: 1) study group (fibrin glue applied on the gastro-jejunal and jejuno-jejunal anastomoses and the mesenteric openings); 2) control group (no fibrin glue, but suture of the mesenteric openings). 322 patients, 161 for each arm, will be enrolled for an estimated period of 24 months. Sex, age, operative time, time to postoperative oral diet and hospital stay, early and late complications rates are evaluated. An interim evaluation was conducted after 15 months. RESULTS: To April 2005, 204 patients were randomized: 111 in the control group (mean age 39.0+/-11.6 years, BMI 46.4 +/- 8.2) and 93 in the fibrin glue group (mean age 42.9+/-11.7 years, BMI 46.9+/-6.4). There was no mortality or conversion in both groups; no differences in operative time and postoperative hospital stay were recorded. Time to postoperative oral diet was shorter for the fibrin glue group (P = 0.0044). Neither leaks nor internal hernias have occurred in the fibrin glue group. The incidence of leaks (2 cases, 1.8%) and the overall reoperation rate were higher in the control group (P=0.0165). CONCLUSION: The preliminary results suggest that Tissucol application has no adverse effects, is not time-consuming, and may be effective in preventing leaks and internal hernias in morbidly obese patients undergoing LRYGBP.