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1.
Langenbecks Arch Surg ; 393(6): 943-8, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18193451

RESUMEN

BACKGROUND: Laparoscopic cholecystectomy is an established treatment for almost all gallbladder diseases with bile duct injury rates similar to open cholecystectomy. These laparoscopic skills must be passed on to junior surgeons without compromising patient safety. MATERIALS AND METHODS: We analysed our structured training programme over 6years (May 2000 to May 2006) by following three trainee surgeons during their training and beyond. During this period, 1,000 laparoscopic cholecystectomies were carried out with five consultant surgeons supervising and three new trainees who completed their accreditation in laparoscopic cholecystectomy. RESULTS: There were 694 patients operated on by consultant surgeons (Group 1), 202 by trainee surgeons (Group 2) and 104 by newly trained surgeons (Group 3). There were no differences between the groups in terms of age and gender. However, there was a significant difference in gallbladder disease among the three groups; Group 2 had more gallstone pancreatitis patients (P < 0.019). There were no differences among the three groups in conversion rates, bile duct injury rates, general complication rates or length of stay. However, the duration of operation in Group 2 was significantly longer compared to the other two groups (P < 0.0001). CONCLUSION: This programme is effective in training junior surgeons and does not compromise patient safety.


Asunto(s)
Colecistectomía Laparoscópica/educación , Cirugía General/educación , Cuerpo Médico de Hospitales/educación , Adulto , Anciano , Competencia Clínica , Consultores , Curriculum , Femenino , Humanos , Tiempo de Internación , Masculino , Mentores , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios de Tiempo y Movimiento , Reino Unido
2.
ANZ J Surg ; 77(3): 146-9, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17305988

RESUMEN

BACKGROUND: Microvascular tumour thrombi in hepatocellular carcinoma (HCC) predict poor outcome and are a risk factor for intrahepatic and extrahepatic metastases. Survival after liver transplantation is also affected. Our aim was to predict the risk factors for the presence of microvascular tumour thrombi. METHODS: Seventy-six patients who had undergone hepatectomy for HCC in our hospital were included in a retrospective analysis from a prospective database. RESULTS: Thirty-one patients (40.8%; mean age 50.7 +/- 12.2 years, P < 0.021) had microvascular tumour thrombi (group T) and 54 patients (group NT; mean age 58.6 +/- 15.4 years) did not. Using logistic regression analysis, we found that more than one HCC nodule, a large tumour, chronic hepatitis C infection and high serum aspartate aminotransferaselevels were significant risk factors for microvascular tumour thrombi. Age, preoperative serum bilirubin level and sex were not significant risk factors. CONCLUSION: Patients with chronic hepatitis C infection having multiple HCC nodules, large tumour size and high preoperative aspartate aminotransferase levels are at high risk for microvascular tumour thrombi.


Asunto(s)
Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/patología , Células Neoplásicas Circulantes/patología , Adulto , Anciano , Análisis de Varianza , Aspartato Aminotransferasas/sangre , Carcinoma Hepatocelular/sangre , Carcinoma Hepatocelular/etiología , Carcinoma Hepatocelular/cirugía , Femenino , Hepatectomía , Hepatitis C Crónica/complicaciones , Humanos , Neoplasias Hepáticas/sangre , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/cirugía , Masculino , Microcirculación , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
3.
Ann Acad Med Singap ; 36(8): 631-5, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17767332

RESUMEN

INTRODUCTION: Laparoscopic cholecystectomy for acute cholecystitis is associated with higher rate of conversion to laparotomy. The value of several factors that might influence the rate of conversion is analysed. MATERIALS AND METHODS: In a retrospective analysis of a prospective database, the medical records of patients who underwent laparoscopic cholecystectomy from May 1998 to June 2004 were reviewed. Patients who had acute cholecystitis and had undergone interval laparoscopic cholecystectomy were included in this study. RESULTS: Out of 1000 laparoscopic cholecystectomies, 201 were operated on for acute cholecystitis. One hundred and forty-five patients (72.3%) underwent successful laparoscopic cholecystectomy and 56 patients (27.7%) needed conversion to open cholecystectomy. Patient's age (P = 0.031), total white cell count (P = 0.014), total bilirubin (P = 0.002), alkaline phosphatase (P = 0.003) and presence of common bile duct stone (P = 0.001) were found to be independently associated with conversion. CONCLUSION: Laparoscopic cholecystectomy can be performed safely for acute cholecystitis. Predictors of conversion will be helpful when planning the laparoscopic approach and for counselling patients preoperatively.


Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Colecistitis Aguda/cirugía , Adulto , Colecistectomía Laparoscópica/estadística & datos numéricos , Colecistitis Aguda/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Factores de Riesgo , Singapur
4.
Surgery ; 140(5): 749-55, 2006 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17084717

RESUMEN

BACKGROUND: Right lobe living donor liver transplantation has become a viable option for adult patients with end-stage liver disease, however, the safety of the donor is of paramount importance. One of the key factors in donor safety is ensuring adequate donor remnant liver volume. METHODS: We retrospectively examined donors who had less than 30% remnant liver volume after right graft procurement. Eighty-six right lobe living donor transplants were carried out in Chang Gung Memorial Hospital, Kaohsiung Medical Center, from January 1999 to December 2004. RESULTS: Eight donors had less than 30% remnant liver volume (Group 1) after graft procurement and 78 donors had remnant liver volume greater than 30% (Group 2). There were no differences in donor characteristics, types of graft, operative parameters, and post-operative liver and renal function as well as liver volume at 6 months post-donation between the 2 groups. The graft weight obtained in Group 1 donors was significantly greater compared with that from Group 2 (P<.005). The overall donor complication rate was 6.98%, and all the complications occurred among group 2 donors. CONCLUSIONS: The judicious use of donors with less than 30% remnant liver volume is safe as a last resort.


Asunto(s)
Hepatectomía/efectos adversos , Trasplante de Hígado/patología , Hígado/patología , Donadores Vivos , Recolección de Tejidos y Órganos/efectos adversos , Adulto , Cuidados Críticos/estadística & datos numéricos , Hígado Graso/epidemiología , Femenino , Humanos , Tiempo de Internación , Hígado/fisiopatología , Trasplante de Hígado/métodos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Tomografía Computarizada Espiral
5.
ANZ J Surg ; 75(6): 436-40, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15943733

RESUMEN

BACKGROUND: With more and more centres worldwide resorting to primary anastomosis for most left sided colonic pathology, the place for a Hartmann procedure seems to be relegated to surgical history books. However, in our centre it is still being performed on a regular basis. As such, we decided to retrospectively look at our results for the procedure. METHODS: All hospital records of patients undergoing the Hartmann procedure between January 1998 and December 2001 were retrospectively analysed looking at demographics, comorbidities and indications of the procedure. RESULTS: There were 52 men and 33 women with a median age of 69 years (range 31-96 years). Sixty-six per cent of the patients had medical comorbidities at the time of the operation. The indications for performing the procedure were: 45 patients for cancer (31 patients for obstruction, 11 patients for perforation, two patients for fistulation to other organs and one for uncontrollable bleeding). 19 patients had the procedure for complicated diverticulitis while four patients had anastomotic leaks, which required conversion to the procedure. Other indications include trauma (four patients), ischemic bowel (six patients) and iatrogenic (one patient). Our median operating time was 160 min (range 50-415 min). Our reversal rate was 32%. Our mortality rate for the first stage was 16% and our morbidity, 51%. The morbidity for the reversal was 29%, with no mortalities. CONCLUSION: Though the idea of primary anastomosis with on table lavage for left sided anastomosis seems attractive, we think the Hartmann procedure is still useful for selected patients.


Asunto(s)
Colon/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Adulto , Anciano , Enfermedades del Colon/cirugía , Neoplasias Colorrectales/cirugía , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Enfermedades del Recto/cirugía , Reoperación , Estudios Retrospectivos
7.
Singapore Med J ; 54(4): 206-11, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23624447

RESUMEN

INTRODUCTION: Endoscopic transenteric stenting is the standard treatment for pseudocysts, but it may be inadequate for treating infected collections with solid debris. Surgical necrosectomy results in significant morbidity. Direct endoscopic necrosectomy (DEN), a minimally invasive treatment, may be a viable option. This study examined the efficacy and safety of DEN for the treatment of infected walled-off pancreatic necrosis and infected pseudocysts with solid debris. METHODS: This study was a retrospective analysis of data collected from a prospective database of patients who underwent DEN in the presence of infected walled-off pancreatic necrosis or infected pseudocysts with solid debris from April 2007 to October 2011. DEN was performed as a staged procedure. Endoscopic ultrasonography-guided transgastric stenting was performed during the first session for initial drainage and to establish endoscopic access to the infected collection. In the second session, the drainage tract was dilated endoscopically to allow transgastric passage of an endoscope for endoscopic necrosectomy. Outcome data included technical success, clinical success and complication rates. RESULTS: Eight patients with infected walled-off pancreatic necrosis or infected pseudocysts with solid debris (mean size 12.5 cm; range 7.8-17.2 cm) underwent DEN. Underlying aetiologies included severe acute pancreatitis (n = 6) and post-pancreatic surgery (n = 2). DEN was technically successful in all patients. Clinical resolution was achieved in seven patients. One patient with recurrent collection opted for surgery instead of repeat endotherapy. No procedural complications were encountered. CONCLUSION: DEN is a safe and effective minimally invasive treatment for infected walled-off pancreatic necrosis and infected pseudocysts.


Asunto(s)
Endoscopía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Enfermedades Pancreáticas/cirugía , Adulto , Anciano , Quistes/diagnóstico , Quistes/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Páncreas/patología , Enfermedades Pancreáticas/diagnóstico , Enfermedades Pancreáticas/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/cirugía , Pancreatitis Aguda Necrotizante/terapia , Singapur , Stents , Resultado del Tratamiento , Ultrasonografía
8.
ISRN Surg ; 2013: 536081, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23762626

RESUMEN

Recurrent pyogenic cholangitis (RPC) is characterized by repeated infections of the biliary system with the formation of stones and strictures. The management aims are to treat acute cholangitis, clear the biliary ductal debris and calculi, and eliminate predisposing factors of bile stasis. Operative options include hepatectomy and biliary drainage procedures or a combination of both; nonoperative options include endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) guided procedures. This current study compares the operative and the nonoperative management outcomes in patients with RPC in 80 consecutive patients. In addition, we aim to evaluate our approach to the management of RPC over the past decade, according to the various degrees of severity and extent of the disease, and identify the patterns of recurrence in this complex clinical condition. Initial failure rate in terms of residual stone of operative compared with nonoperative treatment was 10.2% versus 32.3% (P = 0.020). Long-term failure rate for operative compared with non-operative treatment was 20.4% versus 61.3% (P = 0.010). Based on multivariate logistic regression, the only significant factors associated with failure were bilaterality of disease (OR: 8.101, P = 0.007) and nonoperative treatment (OR: 26.843, P = 0.001). The median time to failure of the operative group was 48 months as compared to 20 months in the nonoperative group (P < 0.010). Thus operative treatment is a durable option in long-term resolution of disease. Hepatectomy is the preferred option to prevent recurrent disease. However, biliary drainage procedures are also an effective treatment option. The utility of nonoperative treatment can achieve a reasonable duration of disease free interval with minimal complications, albeit inferior to operative management.

10.
Eur J Gastroenterol Hepatol ; 24(8): 929-38, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22617363

RESUMEN

BACKGROUND: Patients with recurrent nonvariceal upper gastrointestinal bleeding who have failed endoscopic therapy pose a challenge. Percutaneous transcatheter angiographic embolization (TAE) is an alternative to surgery but remains controversial. This study compares the treatment outcomes in patients with recurrent nonvariceal upper gastrointestinal bleeding. METHODS: A retrospective single-centre study of consecutive patients who underwent TAE (January 2007-December 2010) compared with patients treated surgically (January 2004-December 2010) was conducted. Patient demographics, comorbidities, rebleeding rates, length of stay and mortality were compared. RESULTS: Thirty [23 men; age (SD) 66.5±15.6 years] and 63 [41 men; age (SD) 68.2±15.0 years, NS] patients underwent TAE and surgery after a mean (SD) of 1.7±1.0 and 2.1±1.1 (NS) gastroscopies, respectively, for gastric ulcers (n=28), duodenal ulcers (n=53), small-bowel diverticuli (n=7), jejunal ulcer (n=1) and gastric Dieulafoy's lesions (n=2). Ten (33.3%) and 44 (69.8%) patients who underwent TAE and surgery, respectively, had an American Society of Anesthesiologists status of at least 2 (P=0.001). Higher rebleeding rates were observed after TAE compared with surgery [n=14 (46.7%) vs. 8 (12.7%), P=0.001]; however, there were no significant differences in 30-day mortality (16.7 vs. 19.0%, NS), complication rates (46.7 vs. 60.3%, NS) and length of stay (45.1±9.8 vs. 25.5±18.1 days, P=0.06). Twenty-four out of 30 patients (80%) who underwent TAE achieved haemostasis after a median (SD) of 2.0 (1.2) TAE procedures. Rebleeding occurred in five out of seven patients (71%) who underwent TAE for small-bowel diverticular bleeding. CONCLUSION: TAE averted the need for surgery in high-risk patients. Its role in low surgical risk patients or patients with small-bowel diverticular bleeding requires further study.


Asunto(s)
Embolización Terapéutica/métodos , Endoscopía Gastrointestinal , Hemorragia Gastrointestinal/terapia , Anciano , Anciano de 80 o más Años , Divertículo/cirugía , Divertículo/terapia , Úlcera Duodenal/cirugía , Úlcera Duodenal/terapia , Femenino , Hemorragia Gastrointestinal/mortalidad , Hemorragia Gastrointestinal/cirugía , Gastroscopía , Humanos , Intestino Delgado/anomalías , Intestino Delgado/cirugía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recurrencia , Estudios Retrospectivos , Úlcera Gástrica/cirugía , Úlcera Gástrica/terapia , Resultado del Tratamiento
12.
Am J Surg ; 194(1): 17-22, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-17560903

RESUMEN

BACKGROUND: Long-term survival after hepatectomy for hepatocellular carcinoma is still poor because of tumor recurrence especially in the liver remnant. The risk factors for intrahepatic recurrence after liver resection are studied in our cohort of patients. METHODS: A retrospective analysis from a prospective database was performed on 76 consecutive successful hepatectomies for hepatocellular carcinoma. RESULTS: Twenty-two patients had intrahepatic recurrence. The following were not found to be risk factors for recurrence: age, sex, race, number of segments resected, and mean operating time. By using multivariate analysis, serum aspartate transaminase level, more than 1 hepatocellular carcinoma nodule, and presence of tumor thrombi were found to be significant risk factors. CONCLUSION: Patients who with these risk factors should undergo close follow-up to detect recurrence early; treatment with reresection, chemoembolization, or radiofrequency ablation can be considered.


Asunto(s)
Carcinoma Hepatocelular/terapia , Hepatectomía/efectos adversos , Neoplasias Hepáticas/terapia , Recurrencia Local de Neoplasia/terapia , Adulto , Anciano , Carcinoma Hepatocelular/cirugía , Ablación por Catéter , Quimioembolización Terapéutica , Femenino , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/etiología , Reoperación , Estudios Retrospectivos , Factores de Riesgo
13.
Am J Surg ; 193(1): 5-9, 2007 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17188079

RESUMEN

BACKGROUND: The indications for intervention in cases of benign liver tumors include symptoms, suspicion of malignancy, or risk of malignant change. METHODS: Eighty-four liver resections for benign tumors were performed in our hospital from June 1996 to December 2004. The patient records were reviewed retrospectively. RESULTS: The study group (41 females, 43 males; average age, 41.4 +/- 10.5 y) included 46 cavernous hemangiomas, 27 focal nodular hyperplasias, 5 hepatic adenomas, and 6 liver cysts. The indications for resection were inability to rule out malignancy (50 [59.5%]), symptoms (33 [39.3%]), and others (1 [1.2%]). Postoperatively, 28 of the 33 patients had resolution of symptoms. Twenty-nine patients (34.5%) had chronic hepatitis B infection. CONCLUSIONS: Liver resection for benign liver tumor is safe, but indications for intervention must be evaluated carefully. The presence of chronic parenchymal liver disease does not increase morbidity in these patients.


Asunto(s)
Hepatectomía/efectos adversos , Hepatitis B/etiología , Hepatopatías/etiología , Neoplasias Hepáticas/cirugía , Adenoma/diagnóstico , Adenoma/cirugía , Adulto , Enfermedad Crónica , Quistes/diagnóstico , Quistes/cirugía , Femenino , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/cirugía , Hepatitis B/diagnóstico , Humanos , Hiperplasia , Hígado/patología , Hepatopatías/diagnóstico , Neoplasias Hepáticas/diagnóstico , Masculino , Estudios Retrospectivos
14.
Dig Surg ; 23(5-6): 296-302, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17340765

RESUMEN

BACKGROUND: Pancreaticoduodenectomy is associated with a high degree of morbidity; the main cause is failure of the pancreatic anastomosis. It is imperative that this is performed safely and is secure. Pancreatic leaks will lead to serious morbidity and even mortality. Here we describe the use of a new surgical triple-layer pancreaticojejunostomy in a group of patients with minimal morbidity. METHODS: This is a retrospective review from a prospective database. Fifty-one consecutive patients underwent a pancreaticoduodenectomy (either pylorus-preserving (PPPD) or classical Whipple's) from May 1999 to December 2005 and had the pancreaticojejunostomy reconstructed as described below. RESULTS: The mean age of the 51 patients was 56.71 +/- 9.0 years; 32 (62.7%) were female and 19 (37.3%) were males. The mean operating time was 368.55 +/- 57.94 min; the average blood loss was 396 +/- 236 ml with 15 patients (29.4%) requiring postoperative blood transfusions. The mean pancreatic duct size was 4.94 +/- 2.6 mm. In terms of pancreatic texture, there were 33 (64.7%) hard pancreas and 18 (35.3%) soft pancreas. PPPD was performed on 28 (54.9%) and the classical Whipple's procedure on 23 (45.1%). Twelve patients had postoperative complications; only 1 patient had a pancreatic fistula which was treated conservatively. CONCLUSION: This method is safe and reliable. It can be used for a myriad of pancreas remnants with a wide range of pancreatic duct sizes.


Asunto(s)
Pancreaticoduodenectomía , Pancreatoyeyunostomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento
15.
World J Surg ; 30(9): 1698-704, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16927065

RESUMEN

BACKGROUND: Laparoscopic cholecystectomy is the gold standard treatment for most gallbladder diseases. Conversion to open cholecystectomy is necessary in some patients for any of a number of factors. Identifying these factors will help the patient, the surgeon, and the hospital. METHODS: One thousand laparoscopic cholecystectomies were performed from May 1998 to May 2004 in Changi General Hospital, Singapore; 103 patients (10.3%) required conversion to open cholecystectomy. All data were kept prospectively and analyzed retrospectively. RESULTS: The patients who had conversion were mostly men (P < 0.0001), were heavier (P < 0.05), had acute cholecystitis (P < 0.0001), and had a history of upper abdominal surgery (P < 0.001). There were no differences in terms of race (P = 0.315) and presence of diabetes mellitus (P = 0.126). Diabetic patients who had conversion had a significantly higher glycosylated hemoglobin (Hba1c) (8.9% +/- 0.6%; P < 0.038). Patients who had conversion had a higher total white count (P < 0.05), but liver function tests were similar between the two groups. There was a higher conversion rate among the junior surgeons than the more experience surgeons (P < 0.032). CONCLUSIONS: The significant risk factors for conversion were male gender, advanced age (> 60 years), higher body weight > 65 kg, acute cholecystitis, previous upper abdominal surgery, junior surgeons, and diabetes associated with Hba1c > 6. Chronic liver disease was not found to be a risk factor (P = 0.345), and performing laparoscopic cholecystectomy in cirrhotic patients is safe. Identifying risk factors will help the surgeon to plan and counsel the patient and introduce new policies to the unit. Some of the risk factors are similar to those reported from international centers, but others may be unique to our department.


Asunto(s)
Colecistectomía Laparoscópica , Colecistectomía , Adulto , Colecistectomía/estadística & datos numéricos , Colecistectomía Laparoscópica/estadística & datos numéricos , Colecistolitiasis/epidemiología , Colecistolitiasis/cirugía , Diabetes Mellitus/epidemiología , Femenino , Humanos , Cirrosis Hepática/epidemiología , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo
16.
Clin Transplant ; 20(1): 81-4, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16556159

RESUMEN

BACKGROUND AND OBJECTIVE: Vascular reconstruction is important in liver transplantation because its obstruction causes graft failure and eventual loss. Vascular outflow obstruction may be due to graft malposition. We describe our experience with liver allograft repositioning using tissue expander and Foley catheter to improve hepatic and portal venous outflows. PATIENTS AND METHODS: A total of seven patients who received liver transplantation at our institution developed hepatic and/or portal venous obstruction during final graft positioning detected by Doppler ultrasonography (hepatic vein flow <10 cm/s; portal vein flow <12 cm/s). Chart and operative records of these patients were reviewed. Technique of operation, donor-recipient characteristics, use of tissue expander or Foley catheter to improve venous outflow, complications, and outcome were analyzed. RESULTS: Hepatic and/or portal venous obstruction were detected after portal reperfusion. We used commercially available tissue expander used in plastic surgery and Foley catheter to reposition the graft. Tissue expanders were used in three recipients (age: 27-46 yr). Foley catheters were used in four recipients (age: 7 months-53 yr). One recipient used both tissue expander and Foley catheter. Expanders were filled with 300-770 mL saline and placed into the right subphrenic space. Foley catheters were filled with 15-75 mL saline. Significant improvements in hepatic and/or portal venous outflow were detected by Doppler ultrasonography post-graft repositioning. Aspiration of expander and Foley catheter contents was started from 6th to 27th postoperative day under sonographic guidance. All expanders and catheters were removed by the 19th-56th postoperative day (mean: 38 d). Complications included chylous ascites (1/7), bile leak (1/7), tube drain infection (2/7), septicemia (2/7). All complications were successfully managed by non-operative interventions. There was no outflow obstruction detected by ultrasonography before and after removal of expanders and catheters. One- and two-year graft and patient survivals were both 100%. CONCLUSION: The use of tissue expanders and Foley catheters to improve hepatic and portal venous outflow in malposed liver allografts is a simple and safe method after liver transplantation.


Asunto(s)
Cateterismo , Trasplante de Hígado , Hígado/irrigación sanguínea , Sistema Porta/fisiología , Dispositivos de Expansión Tisular , Adolescente , Adulto , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Lactante , Hígado/diagnóstico por imagen , Trasplante de Hígado/fisiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Periodo Posoperatorio , Flujo Sanguíneo Regional , Ultrasonografía Doppler , Enfermedades Vasculares/prevención & control
17.
Liver Transpl ; 12(6): 950-7, 2006 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16721773

RESUMEN

Complications in a donor are a distressing but inevitable occurrence, since graft procurement is a major undertaking. Although the technique for procurement has some similarities to hepatic resection, a donor is very unlike a patient with malignancy. The risk factors identified in these patients cannot be extrapolated to donors. Donor hepatectomy carried out from June 1995 to March 2005 in Chang Gung Memorial Hospital, Kaohsiung Medical Center was reviewed with the aim of identifying risk factors for complications. There were 204 living donor liver transplants, with 205 donor hepatectomies, as 1 living donor liver transplantation was a dual graft. Ten donors (4.88%) suffered complications. There was no difference in terms of age, gender, body weight, operation, and parenchymal time between those who had complications and those who did not. There was also no difference in liver function tests between the 2 groups of donors, but the total bilirubin was significantly higher in donors with complications. The graft weight and remnant liver volume were also similar. The proportion of donors with fatty liver was the same between the 2 groups. The mean blood loss in donors with complications was 170 +/- 79 mL, and that for donors without complications was 95 +/- 77 mL. There was a statistically significant greater blood loss in donors with complications (P < 0.05). The number of segments removed in donors with complications was also higher compared to donors without complications (P < 0.03). Using multivariate analysis, intraoperative blood loss and the number of segments removed were found to be independent risk factors for donor complications. Intraoperative blood loss during graft procurement must be kept low to minimize complications in donors.


Asunto(s)
Pérdida de Sangre Quirúrgica , Hepatectomía , Donadores Vivos , Complicaciones Posoperatorias , Adulto , Femenino , Humanos , Trasplante de Hígado , Masculino , Factores de Riesgo
18.
Liver Transpl ; 12(2): 264-8, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16447205

RESUMEN

Hepatic venous outflow reconstruction is a key to successful living donor liver transplantation (LDLT) because its obstruction leads to graft dysfunction and eventual loss. Inclusion or reconstruction of most draining veins is ideal to ensure graft venous drainage and avoids acute congestion in the donor graft. We developed donor graft hepatic venoplasty techniques for multiple hepatic veins that can be used in either right- or left-lobe liver transplantation. In left-lobe grafts, venoplasty consisting of the left hepatic vein and adjacent veins such as the left superior vein, middle hepatic vein, or segment 3 vein is performed to create a single, wide orifice without compromising outflow for anastomosis with the recipient's vena cava. In right lobe graft where a right hepatic vein (RHV) is adjacent with a significantly-sized segment 8 vein, accessory RHV, and/or inferior RHV, venoplasty of the RHV with the accessory RHV, inferior RHV, and/or segment 8 vein is performed to create a single orifice for single outflow reconstruction with the recipient's RHV or vena cava. Of 35 venoplasties, 2 developed hepatic venous stenoses which were promptly managed with percutaneous interventional radiologic procedures. No graft was lost due to hepatic venous stenosis. In conclusion, these techniques avoid interposition grafts, are easily performed at the back table, simplify graft-to-recipient cava anastomosis, and avoid venous outflow narrowing.


Asunto(s)
Hepatectomía/métodos , Venas Hepáticas/cirugía , Circulación Hepática/fisiología , Trasplante de Hígado , Donadores Vivos , Procedimientos Quirúrgicos Vasculares/métodos , Anastomosis Quirúrgica , Femenino , Hepatectomía/efectos adversos , Venas Hepáticas/fisiopatología , Humanos , Masculino , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Sensibilidad y Especificidad , Grado de Desobstrucción Vascular/fisiología
19.
World J Surg ; 29(12): 1658-66, 2005 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-16311869

RESUMEN

Liver regeneration after donor hepactectomy offers a unique insight into the process of liver regeneration in normal livers. As the liver restores itself, concurrent splenic enlargement occurs. There are many theories about why this phenomenon takes place: some investigators have proposed a relative portal hypertension that leads to splenic congestion or, perhaps, the presence of a common growth factor that induces both the liver and spleen to enlarge. Between the months of June 2001 and May 2004, 112 live donor liver transplants (LDLTs) were performed in Chang Gung Memorial Hospital, Kaohsiung, Taiwan. The total number of donor hepatectomies performed during this period was 113, however, because one of the cases required dual donors. Of our 113 donors, we eventually analyzed the data of 109; 4 patients were lost to follow-up 6 months later and were excluded from our study. The average age of our donor population was 32.32 +/- 8.48 years. The mean liver volume at donation was noted to be 1207.72 +/- 219.95 cm3, and 6 months later, it was 1027.18 +/- 202.41 cm3. Expressed as a percentage of the original volume, the mean liver volume 6 months after hepatectomy was 90.70% +/- 12.47% in this series. For right graft donors, mean liver volume after 6 months was 89.68% +/- 12.37% of the original liver volume, whereas that for left graft donors was 91.99% +/- 12.6%. Only 26 of the 109 (23.85%) donors were able to achieve full regeneration 6 months post-donation. Notably, liver function profiles of all donors were normal when measured 6 months after operation. The average splenic volume at donation as measured by computed tomography (CT) volumetry was 159 +/- 58 cm3, and the splenic volume 6 months post-donation was 213 +/- 85 cm3. There was a mean increment in splenic volume of 35% +/- 28% 6 months after donation. The blood profiles of the donors were monitored; particular attention was given to platelet levels and liver function tests, and these were found to be within normal limits 6 months after operation. Of note, splenic enlargement was significantly greater among right-sided donors than their left-sided counterparts. Greater splenic enlargement was also observed in those donors who achieved full liver regeneration at their evaluation 6 months postoperatively than in those who did not. Although original liver volume was not re-established in most patients 6 months after liver donation, there seemed to have been no untoward effects to the donor. The factors that affect liver regeneration are complex and myriad. Although there is splenic enlargement at 6 months post-donation in donors of LDLT, there are no untoward effects of this enlargement.


Asunto(s)
Hepatectomía/efectos adversos , Regeneración Hepática/fisiología , Trasplante de Hígado , Donadores Vivos , Esplenomegalia/etiología , Recolección de Tejidos y Órganos/efectos adversos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Esplenomegalia/fisiopatología
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