RESUMO
The number of simultaneous liver-kidney transplants has been increasing. This surgery is associated with an increased risk of complications, longer duration of surgery and longer ischemia time for the renal allograft. Two patients listed for liver-kidney transplant at our center underwent en bloc combined liver-kidney transplantation using donor splenic artery as inflow. Patient 1 previously underwent cardiac catheterization that was complicated by a bleeding pseudoaneurysm of the right external iliac artery that required endovascular stenting of the external iliac artery and embolization of the inferior epigastric artery. Patient 2 was on vasopressor support and continuous renal replacement therapy at the time of transplant. In this paper, we described a novel technique of en bloc liver-kidney transplant with simultaneous reperfusion of both allografts using the donor splenic artery for renal inflow. This technique is useful for decreasing cold ischemia time and total operative time by simultaneous reperfusion of both allografts. It is a useful technical variant that can be used in patients with severe disease of the iliac arteries.
Assuntos
Rejeição de Enxerto/prevenção & controle , Síndrome Hepatorrenal/cirurgia , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Artéria Esplênica , Doadores de Tecidos , Idoso , Anastomose Cirúrgica , Cateterismo Cardíaco/efeitos adversos , Feminino , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Transplante HomólogoAssuntos
Abscesso Encefálico/etiologia , Doença Diverticular do Colo/complicações , Perfuração Intestinal/complicações , Abscesso Hepático/etiologia , Infecções Estreptocócicas/etiologia , Streptococcus intermedius , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Doença Diverticular do Colo/tratamento farmacológico , Doença Diverticular do Colo/cirurgia , Humanos , Perfuração Intestinal/cirurgia , Abscesso Hepático/microbiologia , Abscesso Hepático/terapia , Masculino , Infecções Estreptocócicas/tratamento farmacológicoRESUMO
While several equivalent alternatives are available in the bariatric algorithm, more recently the laparoscopic sleeve gastrectomy (SG) has been gaining traction as an effective means of weight loss in patients with morbid obesity. We present the case of a 39-year-old woman with situs inversus totalis, who was taken to the operating room for laparoscopic SG. The patient had previously undergone a failed open gastric banding procedure 20 months earlier. Awareness of the inherited condition before performing the operation allows for advanced planning and preparation. Subsequent modifications to the standard trocar placement help make the procedure more technically feasible. To our knowledge, this is the first published report of a laparoscopic SG after open gastric banding in a patient with situs inversus totalis. After encountering the initial disorientation, we believe experienced laparoscopic surgeons can perform this procedure successfully and safely.