Four-Year Report of Iatrogenic Bile Duct Injury Repair from a Referral Hepatobiliary Center.

Background: Iatrogenic bile duct injury (BDI) is one of the most common complications that challenge surgeons performing laparoscopic cholecystectomy (LC). As the number of LC surgeries increases, a pattern of BDI is emerging, but little is known about this matter. The purpose of this study was to assess the pattern of post-LC BDIs directed in a referral center in Iran. Methods: Post-BDI patients referred to a hepatobiliary center were studied. Demographic data, clinical status, diagnostic examinations, referral time, post-referral management, and morbidity were analyzed. Results: Nine out of 68 patients had Charcot's cholangitis triad featuring right upper quadrant abdominal pain, fever, and icter. Fever, icter, and itching were the most frequent symptoms. Increased bilirubin, leukocytosis, and abnormal liver function test (LFT) were the most common laboratory abnormalities. 30 patients experienced hepatic artery injury. Out of them, six patients experienced hepatectomy due to hepatic ischemia. Two patients were re-admitted and re-operated, and four patients died. Conclusion: Early and correct treatment by a hepatobiliary surgeon experienced in the management of these types of injuries prevents further complications in patients suffering from iatrogenic BDI. Postoperative complications of bile duct repair, such as anastomosis stricture, are possible; thus, patients need long-term and thorough postoperative observation.

Authentication of important medicinal herbal species through DNA-based molecular characterization.

DNA-based molecular markers have great importance among other methods used for the authentication, detection, and identification of medicinal herbal species. Currently, it is more common to identify the medicinal herbal species (monoherbal or polyherbal forms) morphologically by using sensory, macroscopic, and microscopic methods. DNA-based markers made an easy for accurate detection of herbal species by using the polymerase chain reaction (PCR) which involves in vitro amplification of a particular region of DNA sequence. In the current study, we used heterogenic parts for isolation of DNA from twelve important medicinal herbal species followed by purity determination, and yield calculation. We optimized a PCR reaction using universal primer sets to amplify the target DNA followed by DNA sequencing, and species identification. We also performed phylogenetic analysis for determining the evolutionary relationship between the herbal species, by using MEGAX32 software. Further, we prepared adulterated herbal species samples to validate the method. The method was able to amplify the target gene through PCR in 11 out of 12 herbal species samples (sensitivity 91.66%).The DNA from cinnamon could not yield a truly amplified product. On DNA sequencing, all the amplified products were identified as true herbal species (specificity 100%). In the adulterated samples, non-specific DNA bands were observed after performing the PCR reaction, indicating the mixing of more than one herbal species. To conclude, DNA sequencing-based molecular analysis is advantageous for the correct identification, and detection of adulterated herbal species.

Enhanced recovery after hepatopancreaticobiliary surgery: A single-center case control study.

BACKGROUNDS/AIMS: The aim of this study was to find the safety and effectiveness of enhanced recovery after surgery (ERAS) in patients who undergo hepatopancreaticobiliary (HPB) surgeries and its association with the postoperative complications and survival rate of the patients. METHODS: This study was conducted on patients who underwent HPB surgeries in Imam Khomeini Hospital Complex, Iran from 2018 to 2020. Patients who underwent surgery after from 2019 to February 2020 considered as the ERAS group (n=47) in which ERAS was implemented postoperatively including removing nasogastric tube and initiating surgical diet at 6 hours post operation, and removing intraabdominal drains and Foley catheter at postoperative day one. Other patients (n=43) were considered as the control group in which conventional postoperative care was implemented. RESULTS: Ninety patients with the mean age of 47.3±13.3 yrs/old (range= 17-76) including 39 females were enrolled into the study. There were no significant differences between the demographic and preoperative comorbidities between the two groups. Pain severity of the patients in the ERAS group was significantly lower than the control group (visual analogue scales of 3.4±0.77 vs. 4.47±0.88, p<0.001). However, there were no significant differences between the other postoperative data between the two groups. One patient in each group died during hospitalization period due to myocardial infarction. CONCLUSIONS: ERAS may be safe and effective in patients who undergo HPB surgery and may be associated with less severe postoperative pain.

Impact of reperfusion with blood venting on liver transplantation outcomes; a prospective case-control study.

AIM: This study aimed to evaluate the impact of two different reperfusion techniques on outcomes of LT patients. BACKGROUND: Post-reperfusion syndrome (PRS) during liver transplantation (LT) remains a serious issue for both the surgeon and anesthetist. METHODS: In this prospective study, all liver transplant recipients referred to the liver transplantation department of Imam Khomeini Hospital, Tehran, Iran, from January 2016 to June 2017 were enrolled in the study and were divided into two groups of vented (reperfusion with 300cc blood venting) and non-vented (reperfusion without blood venting) cases. Then, 30-minute intraoperative hemodynamic and biochemical changes, as well as 2-month complications and 6-month mortality, were compared between the groups. RESULTS: 57 LT cases (31 vented and 26 non-vented) were studied (50.9% female). The two groups had a similar age (p = 0.107), sex (p = 0.885), MELD score (p = 0.61), donor warm ischemic time (p = 0.85), recipient warm ischemic time (p = 0.36), cold ischemic time (p = 0.99), comorbid disease (p = 0.502), and etiology of end-stage liver disease (p = 0.281). PRS occurred in 3 (11.5%) patients in the vented group and 4 (12.9%) in the non-vented group (p = 0.69). One (3.8%) patient in the non-vented group and 4 (12.9%) patients in vented group died (p = 0.229). CONCLUSION: Reperfusion with and without blood venting had the same outcome regarding intraoperative hemodynamic and biochemical changes, PRS rate, and postoperative complications, as well as 6-month survival. Thus, it seems that blood venting is not a necessary method for decreasing post-reperfusion complications following LT.