Alveococcosis of the liver - strategy of surgical treatment with special focus on liver transplantation.

BACKGROUND: Echinococcosis is a zoonosis caused by infestation with any of 4 (of the 16) members of the Echinococcus genus, namely Echinococcus granulosus, Echinococcus multilocularis, Echinococcus oligarthus, and Echinococcus vogelii. The aim of this retrospective analysis was to present the outcomes of patients undergoing liver resection and liver transplantation (LT) for E. multilocularis infection. METHODS: A total of 44 patients who underwent surgical treatment of E. multilocularis infection in the period between 1989 and 2014 were included in the study cohort and retrospectively analyzed. RESULTS: LT was performed in 22 patients (50.0%), including 4 of 26 patients undergoing initial non-transplant management. Non-transplant procedures comprised liver resection in 23 patients (88.5%), diagnostic laparoscopy in 2 (7.7%), and left adrenalectomy in 1 patient (3.8%). Post-transplantation survival rates were 90%, 85%, and 75% at 1, 5, and 10 years, respectively. CONCLUSION: In conclusion, LT for E. multilocularis infection is a safe and effective treatment method.

Choice of transplantation techniques and indications for liver transplantation in polycystic liver disease in patients with no signs of end-stage liver disease.

OBJECTIVE: Since the initiation of the Liver Transplant Program, 500 liver procedures have been performed. Polycystic liver disease (PLD) and polycystic kidney-liver disease (PKLD) have been rare indications for orthotopic liver transplantation (OLT). Only 7 patients (1.4%) underwent transplantation due to PLD and PKLD. MATERIALS AND METHODS: The group consisted of 4 patients who underwent OLT (0.8%) and 3 patients who received simultaneous liver kidney transplantation (LKT; 0.6%). Our objective was to analyze the indications for either OLT or combined LKT as well as indications for surgical techniques during OLT among patients with PLD or PKLD. RESULTS: The main indication for OLT was massive hepatomegaly causing severe physical handicaps, fatigue, and clinically advanced malnutrition. All 3 patients with indications for combined LKT were dialysis-dependent. None of the patients had symptoms of end-stage liver disease and/or hepatic failure. In 4 cases, a portal bypass was applied, and the piggy-back method used in the other 3 cases. The hepatectomy caused no uncommon difficulty. In cases of simultaneous transplantations, the kidney was implanted separately after OLT. All patients are alive following the transplantation; major surgical complications have occurred. CONCLUSIONS: Patients with PLD can undergo OLT safely with good results. They benefit from the relief of abdominal distension and anorexia. Patients with PKLD who are dialysis-dependent should undergo simultaneous LKT. The surgical technique was solely dependent on the intraoperative conditions determined during the dissection phase.

Comparison of the results of liver transplantation for elective versus urgent indications.

The authors present an analysis of early and remote liver transplantation outcomes related to the presence of emergent indications among 196 of the 209 operations performed from 1989 to April 2003; namely 178 elective and 18 emergent transplantations. Perioperative mortality was 15%. The survival rate during the first 12 months was 79.8% and within 3 years 73.5% among patients operated on an elective basis (UNOS 3 and 2B). In contrast, patients with acute liver failure (UNOS 1 and 2A) showed rates of 45%, 50%, and 47%, respectively. Liver transplant outcomes depend primarily on the urgency of an operation. Longterm results are much better among patients operated on electively. Liver transplantation in patients with acute hepatic insufficiency is burdened with a high 45% mortality.

The impact of experience of a transplantation center on the outcomes of orthotopic liver transplantation.

The so-called learning factor has been disregarded for many years in analyzing the causes of surgical complications and post-operative mortality; it is also the case for OLT. In our center until April 2003, 209 OLT were performed in 196 patients. We evaluated the impact of experience of the transplantation team on the outcomes of liver transplantation. Thirty-four patients died (mortality rate, 16%) and 1-year survival rate, 64%. Mortality rates varied during different periods of observation due to increasing experience of the transplantation team. The causes of mortality were assessed for a series of 34 patients: it was 75% at the beginning of transplantation procedures while recent deaths have not recently exceeded 10% of cases.

Liver regeneration in living-related donors after harvesting of liver segments II and III or II, III and IV.

BACKGROUND: CT-assisted volumetry permits an estimation of the volume of the graft in liver transplantation, as well as monitoring the donor's liver regeneration. The aim of the study was to observe the restitution of liver tissue in donors after harvesting of the liver fragment for living-related liver transplantation (LRLT). METHODS: The size of the whole liver and of segments II, III and IV was assessed by preoperative CT volumetry in 29 living-related liver donors. Segments II and III were harvested in 22 patients, segments II, III and IV in 6 patients. The remnant liver was assessed by CT volumetry on the 7th and 30th postoperative days. RESULTS: The correlation between the calculated volume of the graft and its weight was linear (r=0.56, p<0.04). Postoperative CT volumetry of the liver of living-related donors showed a different pattern of volume restoration (regeneration index) at both 7 and 30 days between donors who sacrificed segments II and III and those who sacrificed segments II, III and IV. The mean regeneration indexes were significantly higher in donors of segments II, III and IV as compared with donors of segments II and III (7 days, p<0.02; 30 days, p<0.05). DISCUSSION: It is possible that the donor's liver displays a different pattern of growth due to the alteration in blood supply to segment IV.

Liver transplantation in the experience of the centre commencing the program.

From 1989 to 1999, 43 orthotopic liver transplantations (OLT) in 40 patients (3 retransplantations) were performed in our Department. The most common indications for OLT were noninflammatory, primary cholestatic liver diseases and postinflammatory liver cirrhosis. Fourty OLT's were done for elective indications, three--on emergency basis, because of fulminant liver failure. The majority of transplantations was performed with classical technique with the excision of retrohepatic vena cava and routine use of the extracorporeal veno-venous bypass. Only in 4 patients the piggyback technique was used and performed without temporary portocaval anastomosis. All 3 patients transplanted for fulminant liver failure died in the perioperative period. Twenty four patients are still alive and well, the longest period of observation exceeding 5 years.

Liver graft bile duct necrosis--indication for retransplantation.

The authors describe the first in Poland case of liver retransplantation in an adult recipient, in whom the indication for the procedure was bile duct necrosis following liver transplantation due to liver cirrhosis of an uncertain origin.

[Complications of laparoscopic cholecystectomy]. / Powiklania cholecystektomii laparoskopowej.

Complications of laparoscopic cholecystectomy were evaluated in the group of 1.284 patients operated on from June 1991 to December 1996. Serious complications were observed in 38 (2.9%) patients. Conversion to open cholecystectomy was required in 50 patients, including 4 patients with common bile duct injury, 3 patients with bleeding from the gall bladder bed, 2 with cholecysto-duodenal fistula and 6 with intraperitoneal adhesions. In 35 patients the conversion was performed due to inflammatory changes in the Calot triangle. The authors did not observe any serious vascular injury as well as lethal complications. They conclude, that the correct indications to surgery and adequate surgical technique are the most important factors preventing the complications.

[Results of surgical treatment for Zenker's diverticula]. / Wyniki leczenia chirurgicznego uchylków Zenkera.

From 1976 to 1996, thirty nine patients were surgically treated for pharyngoesophageal diverticulum. The present study aimed to compare two methods of operative treatment of Zenker's diverticulum: excision (group I) and pexy, both of which were associated with upper esophageal sphincter myotomy. The main indication for surgery was dysphagia. The diagnosis of Zenker's diverticulum was based on clinical symptoms and the result of upper GI tract barium examination. In 75% of patients the diameter of diverticulum exceeded 2 cm. No patient died in the perioperative period. The main complications observed in the postoperative period were of pulmonary origin. In group I (excision) a leakage from the suture line occurred in 2 patients (12.5%). Time of follow-up ranged from 1 to 20 years (mean: 7 years). The comparison of both methods of treatment employed is in favour of diverticulopexy, being a safer and less complications-bearing method, although both of them give similar functional results.

[Esophageal resection for cancer--analysis of postoperative complications from personal materials]. / Resekcje przelyku z powodu raka--analiza powiklan pooperacyjnych w materiale wlasnym.

The aim of the present study was to analyse the rate of postoperative complications in patients after esophageal resection for cancer, as well as the dependence of its frequency from surgical tactics employed during the operation. Postoperative complications occurring in 38 patients who underwent esophagectomy and intrathoracic esophagogastric anastomosis (treated from 1978 to 1987) were compared with the same data of 74 patients (1988-1996) in whom the operation consisted of the total intrathoracic esophagectomy, cardia, lesser curvature of the stomach and large regional lymph nodes dissection. In these latter cases the esophagogastric anastomosis was performed in the neck. The most frequent postoperative complications in both groups were of cardiopulmonary origin. The anastomotic leak occurred less frequently in patients with cervical esophagogastric anastomosis. However, when occurred, healing was more likely by local drainage and conservative treatment. Anastomotic leaks after intrathoracic esophagogatric anastomoses were usually fatal. In these cases the only chance of patient's survival was an aggressive surgical treatment consisting of disconnection of alimentary tract: esophageal fistula in the neck and feeding jejunostomy.

[Treatment of liver injuries in personal clinical material from 1990-1996]. / Leczenie obrazen watroby w materiale wlasnym Kliniki w latach 1990-1996.

From 1990 to 1996 two hundred and sixteen patients with abdominal trauma were treated in our Department. In 170 cases there were blunt, and in 46-penetrating injuries (stab and gunshot wounds). Injuries of the other regions of the body coexisted in 117 patients (multiple trauma). In 42 cases (19.4%) abdominal trauma caused injury to the liver. In this group blunt mechanism of trauma also dominated (71%). The victims were usually young men (90% of the group, mean age - 35.3 years). The most common cause of injury were traffic accidents (47.6%), penetrating injury being the second commonest cause (12 patients i.e. 29%). Four patients were treated conservatively, the remaining 38 required surgical intervention. Most frequently liver suture and peritoneal drainage were performed (20), followed by liver tissue resections (16) and liver packing (12). Other surgical procedures to treat coexisting injuries were performed in 24 patients. In 22 patients postoperative complications occurred: liver abscess in 6 cases, hemorrhage in 4, wound infection in 4, biliary fistula in 2, intrahepatic aneurysm in 2 and other complications in 8 patients. The mean time of hospitalisation were of 20 days (range: 0-64 days). Mean volume of blood transfused equaled 6.9 U. There were 16 deaths (38%), in all cases in multiple trauma victims. All patients with penetrating liver trauma survived.

[Analysis of morbidity risk in patients after liver resection]. / Analiza ryzyka powiklan u chorych po resekcjach watroby.

The authors present the retrospective analysis of the morbidity risk in patients undergoing hepatic resection for various indications. The most important complications, according to the literature, were: postoperative liver failure, massive pleural effusion, ascites resistant to pharmacological treatment, intraperitoneal hemorrhage or septic complications requiring relaparotomy. There was the correlation between the increased morbidity and preoperative risk factors like: diabetes mellitus, liver insufficiency with coagulopathy, and intraoperative blood loss, requiring massive transfusions.

[Complications after liver resection for benign lesions]. / Powiklania po resekcjach watroby z powodu lagodnych zmian ogniskowych.

The paper presents the results of 76 hepatic resection in the group of patients with benign liver lesions. The most common indication to the resection were liver cysts and hemangioma. Morbidity occurred in 13% of patients. After liver trauma the highest mortality we observed.

Endoscopic laser treatment of benign tracheal stenoses.

We present the technique and results of endoscopic neodymium-yttrium aluminum garnet laser treatment of benign tracheal stenoses. This therapy was used in 15 patients with tracheal stenoses. Benign tracheal granulomas were caused by prolonged tracheal intubation in eight patients, permanent maintenance of tracheostomy tube in five patients, and nonspecific inflammatory process of the trachea in two patients. The clinical picture was dominated by dyspnea and stridor. The achievement of normal tracheal patency required several laser therapy sessions, repeated at 5- to 7-day intervals. In 30% of patients additional laser vaporization was required as well. The immediate and short-term results were encouraging; in all cases the normal tracheal lumen was restored, resulting in alleviation of patients' symptoms.