Optimal surgical workup to ensure safe recovery of the donor after living liver donation - A systematic review of the literature and expert panel recommendations.

BACKGROUND: The essential premise of living donor liver transplantation is the assurance that the donors will have a complication-free perioperative course and a prompt recovery. Selection of appropriate donors is the first step to support this premise and is based on tests that constitute the donor workup. The exclusion of liver pathologies and assessment of liver anatomy and volume in the donor candidate are the most important elements in the selection of the appropriate candidate. OBJECTIVE: To determine whether there is evidence to define an optimal donor surgical workup that would improve short-term outcomes of the donor after living liver donation. DATA SOURCES: Ovid Medline, Embase, Scopus, Google Scholar, and Cochrane Central. METHODS: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. RESULTS: Although a liver biopsy remains the only method to exactly determine the percentage and type of steatosis and to detect other liver pathologies, its routine use is not supported. Both magnetic resonance imaging (MRI) and computed tomography (CT) appear to be adequate for quantifying liver volume; the preference for one or the other is often based on center expertise. MRI is clearly a better technique to assess biliary anatomy, although aberrant biliary anatomy may not be clearly detected. MRI is also more accurate than CT in determining low grades of steatosis. CT angiography is the imaging test of choice to assess the vascular anatomy. There is no evidence of the need for catheter angiography in the modern evaluation of a living liver donor. CONCLUSIONS: A donor liver biopsy is indicated if abnormalities are present in serological or imaging tests. Both MRI and CT imaging appear to be adequate methodologies. The routine use of catheter angiography is not supported in view of the adequacy of CT angiography in delineating liver vascular anatomy. No imaging modality available to quantify liver volume is superior to another. Biliary anatomy is better defined with MRI, although poor definition can be expected, particularly for abnormal ducts.

Laparoscopic appendectomies: experience of a surgical unit.

Appendicitis is one of the most common causes of acute abdomen in adults and appendectomy is the most common emergency abdominal procedure. Laparoscopic appendectomy has gained popularity only in recent years and the optimal approach for the treatment of acute appendicitis is still under debate. This retrospective study aimed at examining the current indications for laparoscopic appendectomy. 1024 patients undergoing laparoscopic appendectomy between February 1992 and December 2007 were retrospectively reviewed. 39.9% of patients (n=408) underwent emergency surgery. In 616 cases (60.1%) conservative management was performed in vain and these patients underwent an elective operation. In the 36 patients with an intraoperative normal appendix, other pathological findings were laparoscopically detected and treated. Conversion to an open procedure was required for 13 (1.3%) cases. The mean operative time was 38 min and the average length of postoperative hospitalization was 2.5 days. The overall morbidity rate was 2.6%. Laparoscopic appendectomy should be considered a procedure of choice for the treatment of non-complicated appendicitis. We stress the possibility to laparoscopically treat even complicated appendicitis in the surgical setting with substantial experience in minimally invasive surgery.