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1.
Chirurgia (Bucur) ; 116(5): 524-532, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34749848

RESUMO

Bile duct injuries represent the most dramatic complications after an open or laparoscopic cholecystectomy. The detrimental effects on patient quality of life and overall survival are the most obvious consequences of such injuries. An effective treatment strategy after accurate mapping of the injury type is the only method of averting these morbid consequences. Several classification systems have been proposed in an attempt to accurately describe and categorize bile duct injuries. The critical question is whether we truly need all these systems and whether each of these systems adds value to the existing knowledge base, or further obscures the field. Each classification system has several advantages to base its clinical utility on, but entails a reasonable number of limitations as well. Currently, a tailored approach adopting the classification system which provides the most appropriate guidance - either in terms of diagnosis or treatment decision making - appears to be the most justified option.


Assuntos
Colecistectomia Laparoscópica , Qualidade de Vida , Ductos Biliares/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Humanos , Doença Iatrogênica , Complicações Intraoperatórias , Resultado do Tratamento
2.
PLoS One ; 16(9): e0257828, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34559849

RESUMO

Covered self-expandable metal stents (CSEMS) are often used for palliative endoscopic biliary drainage; however, the unobstructed period is limited because of sludge occlusion. The present study aimed to evaluate the biosafety of a novel poly(2-methoxyethyl acrylate)-coated CSEMS (PMEA-CSEMS) for sludge resistance and examine its biosafety in vivo. Using endoscopic retrograde cholangiopancreatography, we placed the PMEA-CSEMS into six normal porcine bile ducts and conventional CSEMS into three normal porcine bile ducts. We performed serological examination and undecalcified histological analysis at 1, 3, and 6 months during follow-up. In the bile ducts with PMEA-CSEMS or conventional CSEMS, we observed no increase in liver enzyme or inflammatory marker levels in the serological investigations and mild fibrosis but no inflammatory response in the histopathological analyses. Thus, we demonstrated the biosafety of PMEA-CSEMS in vivo.


Assuntos
Acrilatos/química , Ductos Biliares/cirurgia , Polímeros/química , Stents Metálicos Autoexpansíveis/efeitos adversos , Acrilatos/efeitos adversos , Animais , Análise Química do Sangue , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Fígado/enzimologia , Modelos Animais , Polímeros/efeitos adversos , Sus scrofa
3.
Chirurgia (Bucur) ; 116(4): 480-483, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34498570

RESUMO

As laparoscopic surgery has evolved, open cholecystectomy has been replaced with a new minimally invasive approach which is considered nowadays the gold-standard technique. Laparoscopic cholecystectomy has brought multiple advantages in terms of outcomes; however, the incidence of complex biliary injuries has been noticed. The portojejunostomy was first performed for pediatric patients with biliary atresia, involving the attachment of a Roux-en- Y loop to the porta hepatis in order to restore the bilioenteric continuity. In complex cases, with no options of reconstruction after biliary lesions, this technique has become a salvage procedure in adult surgery.


Assuntos
Ductos Biliares Extra-Hepáticos , Atresia Biliar , Colecistectomia Laparoscópica , Adulto , Anastomose em-Y de Roux , Ductos Biliares/cirurgia , Atresia Biliar/cirurgia , Criança , Humanos , Resultado do Tratamento
4.
Updates Surg ; 73(5): 1709-1716, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34347275

RESUMO

Adequate exposure with optimal anteroposterior view of the hilar plate is challenging and crucial in a surgical repair of complicated hilar bile duct injuries. A high-quality anastomosis depends on the ability to identify non-scarred, non-inflamed, non-ischemic bile ducts. This study provides operative details of the Partial Segments 4/5 Liver Resection with a Roux-en-Y hepaticojejunostomy (PS4/5LRHJ) and presents its long-term outcomes. 36 patients with the Strasberg type E bile duct injuries (BDIs) who underwent the PS4/5LRHJ from 2003 to 2019 were retrospectively reviewed. Outcomes of the surgical treatments were analyzed. The mean age of the patients was 46.3 years. 22 patients underwent BDI repair as index operations and 14 patients as re-repair operations. Operative times between the index operation group and the re-repair group (396.6 min vs 391.3 min, respectively, p = 0.876) and blood loss (590.6 ml vs 640 ml, respectively, p = 0.587) were not statistically different. The mean length of hospital stay was 23 days. The median follow-up duration was 73 months. Major complications developed in 10 patients (27.8%), of which intra-abdominal collection was the most common (eight patients, 22.2%). Anastomotic stricture developed in one patient (2.8%). The mortality rate was zero. The overall 10-year patency rate was 95.2%. PS4/5LRHJ offered long-term patency with acceptable morbidity in the hilar bile duct injuries and re-repair operations.


Assuntos
Anastomose em-Y de Roux , Colecistectomia Laparoscópica , Ductos Biliares/cirurgia , Hepatectomia , Humanos , Recém-Nascido , Fígado , Estudos Retrospectivos , Resultado do Tratamento
5.
Surgery ; 170(4): 1006-1013, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34389163

RESUMO

BACKGROUND: Nonalcoholic fatty liver disease, which is highly associated with obesity, includes nonalcoholic steatohepatitis. Lipopolysaccharides from the intestine would induce inflammation in the liver in nonalcoholic fatty liver disease. This study aimed to examine the role of the bilio-pancreatic limb in the effect of duodenal-jejunal bypass on nonalcoholic steatohepatitis, with respect to the gut-liver axis, using a rat model. METHODS: Nonalcoholic steatohepatitis model rats were randomly assigned into 3 groups as follows: 1 sham group and 2 duodenal-jejunal bypass groups. The 2 duodenal-jejunal bypass groups were defined according to the bilio-pancreatic limb length: 30 cm (30-DJB group) and 0 cm (0-DJB group). Pathology findings and blood biochemistry, inflammatory cytokine and lipopolysaccharides receptor mRNA in the liver and common channel, and lipopolysaccharide-binding protein level in the portal vein were assessed. RESULTS: The reduction in plasma alanine aminotransferase and nonalcoholic fatty liver disease activity score in the 30-DJB group was not observed in the 0-DJB group, similar to the sham group. In the liver tissue, mRNA of inflammatory cytokines and lipopolysaccharide receptors, the area occupied by CD68-positive macrophages, and the number of CD3-positive T-lymphocytes on immunostaining were lower in the 30-DJB group; however, these findings were not observed in the 0-DJB group, and lipopolysaccharide-binding protein levels in the portal vein and mRNA expressions of inflammation-related genes in the common channel showed similar tendencies. CONCLUSION: The bilio-pancreatic limb plays an important role in the beneficial effect of duodenal-jejunal bypass for nonalcoholic steatohepatitis. The bilio-pancreatic limb may suppress lipopolysaccharides-related cascades in the liver by reducing intestinal inflammation.


Assuntos
Ductos Biliares/cirurgia , Duodeno/cirurgia , Jejuno/cirurgia , Fígado/cirurgia , Hepatopatia Gordurosa não Alcoólica/cirurgia , Ductos Pancreáticos/cirurgia , Anastomose Cirúrgica/métodos , Animais , Modelos Animais de Doenças , Progressão da Doença , Masculino , Ratos , Ratos Sprague-Dawley
7.
Georgian Med News ; (314): 155-162, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-34248047

RESUMO

The aim of the study was to develop a new method of formation of biliodigestive anastomoses, which would make it possible to form anastomoses both on unchanged bile ducts and in conditions of their inflammation. An experimental study was carried out on 50 rabbits of the "Chinshila" breed, which formed biliodigestive and interintestinal anastomoses by the method of high-frequency (HF) electric welding using the "Patonmed EKVZ-300" coagulator. Anastomoses were formed both on non-inflamed tissues and under conditions of biliary peritonitis. In different terms after the operation macro- and microscopic examination of the formed anastomoses was carried out, their patency, tightness and strength were determined. With HF-electric welding the connection of biological tissues is achieved due to thermal adhesion, the mucous and serous layers in the area of the anastomosis are almost completely destroyed under the influence of electricity and the connection occurs due to the submucosal layer. The suture is well-established, hermetically sealed, the anastomoses have sufficient strength (40-100 mm Hg). The coagulation scar is narrow, thermal damage to the membranes is local (within 2700-3000 microns), the epithelialization of the suture was completed after 3 months and the maturation of the scar after 6 months. The method of HF-electric welding equally allows the formation of reliable biliodigestive and interintestinal anastomoses, both in conditions of unchanged and inflamed tissues. The everting weld connection prevents the occurrence of anastomotic strictures in the future.


Assuntos
Soldagem , Anastomose Cirúrgica , Animais , Ductos Biliares/cirurgia , Eletricidade , Coelhos , Suturas
8.
J Am Coll Surg ; 233(2): 222, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34304818
9.
Tissue Eng Regen Med ; 18(5): 887-893, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34216376

RESUMO

BACKGROUND: Bile duct injury (BDI), which may occur during cholecystectomy procedures and living-donor liver transplantation, leads to life-altering complications and significantly increased mortality and morbidity. Tissue engineering, as an emerging method, has shown great potential to treat BDI. Here, we aimed to explore the application of small intestinal submucosa (SIS) matrix composites with bone marrow mesenchymal stem cells (BMSCs) to treat BDI in a rabbit model. METHODS: Rabbit-derived BMSCs were used as seed cells. Porcine SIS was used as the support material. Five centimetres of the common bile duct was dissected, and 1/3-1/2 of the anterior wall diameter was transversely incised to construct the rabbit BDI model. Then, SIS materials without/with BMSCs were inserted into the common bile duct of the BDI rabbits. After 1, 2, 4, and 8 weeks of implantation, the common bile duct was removed. Haematoxylin and eosin (HE) staining was used to assess pathological alterations in the common bile duct, while immunohistochemical staining and western blotting were used to detect expression of the epithelial cell markers CK19 and E-cadherin. Scanning electron microscopy was used to evaluate BMSC growth. RESULTS: Compared with BMSCs alone, SIS-attached BMSCs had increased growth. HE staining showed that the injured bile duct healed well and that the complex gradually degraded as the time from implantation increased. Immunohistochemical staining and western blotting showed that compared with the control group, the in vivo complex group had significantly elevated expression levels of CK19 and E-cadherin. CONCLUSION: BMSC implantation into SIS could improve BDI in rabbits, which might have clinical value for BDI treatment.


Assuntos
Transplante de Fígado , Células-Tronco Mesenquimais , Animais , Ductos Biliares/cirurgia , Células da Medula Óssea , Humanos , Doadores Vivos , Coelhos , Suínos
10.
Z Gastroenterol ; 59(11): 1197-1204, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34298580

RESUMO

BACKGROUND AND AIMS: The complete occlusion of bilioenteric anastomoses is a rare and challenging clinical condition. Repeated surgery is burdened with technical difficulties and significant morbidity. We report the first series of completely occluded bilioenteric anastomoses resp. distal bile duct successfully treated by simultaneous percutaneous and retrograde endoscopic interventions. PATIENTS AND METHODS: This case series includes 4 patients with obstructive jaundice and/or recurring cholangitis and pain due to complete fibrotic occlusion of a hepaticojejunostomy (3 patients) and the distal bile duct (1 patient). After performing PTCD and stepwise dilation of the biliocutaneous tract, we tried to approach the occluded anastomosis from 2 sides by simultaneous percutaneous cholangioscopy and peroral device-assisted enteroscopy/duodenoscopy. By cutting through the separating tissue layer with a needle knife under endoscopic and fluoroscopic control using diaphanoscopy, a new anastomosis should be established followed by dilation of the neoanastomosis with subsequent percutaneous transhepatic drainage for a minimum of 1 year to prevent re-occlusion. RESULTS: The Rendez-vous maneuver was successful in 3/4 cases. In one case, the retrograde access to the anastomosis failed, so the neoanastomosis was cut under cholangioscopic and fluoroscopic guidance only. The neoanastomosis could be established successfully in all 4 cases. Jaundice, cholangitis, and pain disappeared. Minor periinterventional adverse events were cholangitis (n = 1) and pneumonia (n = 1) due to aspiration, which could be managed conservatively. No serious adverse events were observed, and no re-occlusion of any neoanastomosis occurred during the follow-up before and after removal of the percutaneous drainage. CONCLUSION: Simultaneous percutaneous cholangioscopy and device-assisted enteroscopy/duodenoscopy with endoscopic creation of a neoanastomosis is a possible concept for the treatment of completely occluded bilioenteric anastomoses and distal bile ducts. This case series confirms the feasibility, safety, and long-term effectiveness of this treatment.


Assuntos
Colangite , Laparoscopia , Anastomose Cirúrgica , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco , Drenagem , Humanos
11.
BMJ Open ; 11(7): e049449, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34326053

RESUMO

INTRODUCTION: Bile leakage is a frequent complication after liver resection associated with the need of interventional drainage, endoscopic retrograde cholangio pancreatography (ERCP) or reoperation. The intraoperative application of the white test could be a promising strategy to reduce the occurrence of bile leakages. Therefore, we propose to conduct the first multicentric randomised controlled trial with rate of postoperative bile leakage as primary endpoint with and without the white test. METHODS AND ANALYSIS: The Bile-Leakage Trial trial is an investigator-initiated randomised controlled, parallel group, double-blinded, multicentric, superiority trial in four Swiss centres. A total of 210 patients undergoing a resection of at least 2 liver segments will be randomly allocated intraoperatively to either the intervention (identification of open bile ducts with administration of 20-40 mL SMOFlipid5% in the bile tract) or the control group (identification with a white gauze on the liver resection surface).Primary outcome will be the comparison of the postoperative bile leakage rate in both groups within 30 days after liver resection, defined according to the classification of the International Study Group of Liver Surgery. Secondary outcomes will be operative and postoperative complication, including severity grade of the bile leakage, rate of ERCP, interventional drainage, morbidity, intensive care unit stay, and mortality. ETHICS AND DISSEMINATION: The cantonal ethics committees of all participating centres and Swissmedic approved the study. SMOFlipid20% consists of a mixture of oils, no side effects resulting from the intraoperative application of 20-40 mL in the biliary tract with consecutive enteral absorption are expected nor are side effects described in the literature. SMOFlipid20% will be diluted intraoperatively with isotonic saline solution to a concentration of 5%. The results of the BiLe-Trial will be submitted to a peer-reviewed journal regardless of the outcome. As this is an investigator-initiated trial, data are property of the sponsor investigator and can be obtained on request. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov, ID: NCT04523701. Registered on 25 August 2020.Swiss National Clinical Trials Portal (SNCTP), ID: SNCTP000004200. Registered on 20 January 2021. PROTOCOL VERSION: V3.2_14-12-2020_clean.pdf.


Assuntos
Bile , Hepatectomia , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Humanos , Fígado , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Transplant Proc ; 53(6): 1962-1968, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34233848

RESUMO

BACKGROUND: In right-lobe liver grafts, variations in the biliary tree anatomy can result in multiple bile duct orifices. We present our experience of 10 patients in which biliary reconstruction was performed with the cystic duct for 1 of the anastomoses with 2 separated ducts. Also, we investigated whether the bile duct anastomosis technique, number of bile duct anastomoses, and use of biliary stents affect the rate of biliary complications. METHODS: We evaluated patients who underwent right-lobe living donor liver transplantation (LDLT) at Istinye University Hospital and Istanbul Aydin University Hospital between December 2017 and June 2020. The patients were divided into 4 groups: duct-to-duct (D-D), duct-to-sheath, double duct-to-duct, and duct-to-duct plus cystic duct-to-duct. Biliary complication rates were compared among these 4 groups, between single- and double-duct groups, and between stent (+) and stent (-) groups. RESULTS: Ninety-three patients who underwent right-lobe LDLT (60 men, 33 women) with a mean age of 51 ± 13 years were included. Mean follow-up time was 18.5 ± 8.3 months. The overall biliary complication rate was 17.2% for all patients, 12.1% for the D-D (single-duct) group (33 patients), 16.1% for the duct-to-sheath group (31 patients), 26.3% for the double duct-to-duct group (19 patients), 20% for the duct-to-duct plus cystic duct-to-duct group (10 patients), 20% for the double-duct group (60 patients), 14.5% for the stent (+) group (69 patients), and 25% for the stent (-) group (24 patients). There were no significant differences among these groups in terms of biliary complication rates. Bile stricture occurred in only 1 cystic duct anastomosis (10%), and no bile leakage was observed. CONCLUSIONS: Multiple D-D biliary reconstruction using the cystic duct with external drainage tubes is feasible and safe for LDLT.


Assuntos
Transplante de Fígado , Adulto , Anastomose Cirúrgica , Ductos Biliares/cirurgia , Ducto Cístico/cirurgia , Feminino , Humanos , Fígado , Transplante de Fígado/efeitos adversos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
14.
J Med Chem ; 64(13): 9537-9549, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34142552

RESUMO

Hepatic fibrosis commonly exists in chronic liver disease and would eventually develop to cirrhosis and liver cancer with high fatality. Phosphodiesterase-9 (PDE9) has attracted profound attention as a drug target because of its highest binding affinity among phosphodiesterases (PDEs) with cyclic guanosine monophosphate. However, no published study has reported PDE9 inhibitors as potential agents against hepatic fibrosis yet. Herein, structural modification from a starting hit LL01 led to lead 4a, which exhibited an IC50 value of 7.3 nM against PDE9, excellent selectivity against other PDE subfamilies, and remarkable microsomal stability. The cocrystal structure of PDE9 with 4a revealed an important residue, Phe441, capable of improving the selectivity of PDE9 inhibitors. Administration of 4a exerted a significant antifibrotic effect in bile duct-ligation-induced rats with hepatic fibrosis and transforming growth factor-ß-induced fibrogenesis. This therapeutic effect was indeed achieved by selectively inhibiting PDE9 rather than other PDE isoforms, identifying PDE9 inhibitors as potential agents against hepatic fibrosis.


Assuntos
3',5'-AMP Cíclico Fosfodiesterases/antagonistas & inibidores , Descoberta de Drogas , Fibrose/tratamento farmacológico , Inibidores de Fosfodiesterase/farmacologia , 3',5'-AMP Cíclico Fosfodiesterases/metabolismo , Animais , Ductos Biliares/metabolismo , Ductos Biliares/cirurgia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Fibrose/metabolismo , Humanos , Estrutura Molecular , Inibidores de Fosfodiesterase/síntese química , Inibidores de Fosfodiesterase/química , Ratos , Relação Estrutura-Atividade
15.
Clin Oral Implants Res ; 32(8): 980-988, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34114694

RESUMO

OBJECTIVES: Chronic liver disease increases the risk for periodontal disease and osteoporotic fractures, but its impacts on bone regeneration remain unknown. Herein, we studied the impact of liver cirrhosis on peri-implant bone formation. MATERIAL AND METHODS: A total of 20 male Wistar rats were randomly divided into two groups: one with the common bile duct ligated (BDL) and the respective sham-treated control group (SHAM). After four weeks of disease induction, titanium mini-screws were inserted into the tibia. Successful induction of liver cirrhosis was confirmed by the presence of clinical symptoms. Another four weeks later, peri-implant bone volume per tissue volume (BV/TV) and bone-to-implant contact (BIC) were determined by histomorphometric analysis. RESULTS: Peri-implant bone formation was not significantly different between the SHAM and BDL groups. In the cortical compartment, the median percentage of peri-implant new bone was 10.1% (95% CI of mean 4.0-35.7) and 22.5% (13.8-30.6) in the SHAM and BDL groups, respectively (p = .26). Consistently, the new bone in direct contact with the implant was 18.1% (0.4-37.8) and 23.3% (9.2-32.8) in SHAM and BDL groups, respectively (p = .38). When measuring the medullary compartment, the new bone area was 7.1% (4.8-10.4) and 10.4% (7.2-13.5) in the SHAM and BDL groups, respectively (p = .17). Medullary new bone in direct contact with the implant was 10.0% (1.2-50.4) and 20.6% (16.8-35.3) in SHAM and BDL groups, respectively, and thus comparable between the two groups (p = .46). CONCLUSIONS: Bile duct ligation has no significant impact on the early stages of peri-implant bone formation.


Assuntos
Doença Hepática Crônica Induzida por Substâncias e Drogas , Implantes Dentários , Animais , Ductos Biliares/cirurgia , Masculino , Osseointegração , Ratos , Ratos Wistar , Titânio
16.
Rev. cuba. cir ; 60(2): e1089, tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1280219

RESUMO

Introducción: La descompresión con sonda nasogástrica y la vía oral cerrada por varios días, ha sido práctica común tras procedimientos quirúrgicos electivos del tracto digestivo. Los programas para mejorar la recuperación posoperatoria (Enhanced Recovery After Surgery), aconsejan cambiar esta práctica. Objetivo: Evaluar el cumplimiento y repercusión en la evolución posoperatoria de dos acciones del programa en el retiro de la sonda nasogástrica y la apertura de la vía oral el día de la intervención. Métodos: Se realizó un estudio prospectivo, en el Servicio de Cirugía General del Hospital "Hermanos Ameijeiras" de septiembre 2017 a agosto 2020. La muestra fue de 270 pacientes con intervención quirúrgica mayor electiva del colon, hígado, vía biliar o páncreas, a los que se les aplicó el programa para mejorar la recuperación posoperatoria. Resultados: En 79,6 por ciento de pacientes, la sonda nasogástrica se retiró en el quirófano tras la intervención y esto se asoció a más rápida recuperación de la función intestinal, menor estadía, complicaciones, reingresos y reintervenciones. En 60 por ciento se inició la vía oral 6 horas después de la cirugía y 79,6 por ciento toleraban dieta blanda a las 48 horas. Estos pacientes presentaron menos complicaciones y mortalidad. Conclusiones: En el contexto de un programa para mejorar la recuperación posoperatoria, tras cirugía abdominal electiva, el retiro de la sonda nasogástrica el día de la intervención, con apertura precoz de la vía oral y rápida progresión a dieta blanda, son acciones bien toleradas que repercuten positivamente en la evolución posoperatoria(AU)


Introduction: Nasogastric tube decompression, together with the oral route closed for several days, has been a common practice after elective surgical procedures of the digestive tract. Programs to improve postoperative recovery (Enhanced Recovery After Surgery) advise changing this practice. Objective: To assess compliance and impact on postoperative evolution of two program actions for nasogastric tube removal and opening of the oral route on the intervention day. Methods: A prospective study was carried out, from September 2017 to August 2020, in the general surgery service of Hermanos Ameijeiras Hospital. The sample consisted of 270 patients who underwent major elective surgery of the colon, liver, bile duct or pancreas and were applied the program to improve postoperative recovery. Results: In 79.6 percent of patients, the nasogastric tube was removed in the operating room after the intervention, a fact associated with faster recovery of intestinal function, shorter stay, as well as fewer complications, readmissions and reinterventions. In 60 percent of the patients, the oral route was started at six hours after surgery, while 79.6 percent of them tolerated a soft diet at 48 hours. These patients presented fewer complications and mortality. Conclusions: In the context of a program to improve postoperative recovery after elective abdominal surgery, nasogastric tube removal on the intervention day, with early opening of the oral route and rapid progression to a soft diet, are well-tolerated actions that have a positive effect on postoperative evolution(AU)


Assuntos
Humanos , Procedimentos Cirúrgicos Operatórios/métodos , Ductos Biliares/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Trato Gastrointestinal/lesões , Recuperação Pós-Cirúrgica Melhorada , Estudos Prospectivos
17.
J Am Coll Surg ; 233(3): 357-368.e2, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34111534

RESUMO

BACKGROUND: The current study aimed to assess the performance of the 3-level complexity classification that stratified liver resection procedures into 3 complexity grades (grade I, low; grade II, intermediate; and grade III, high complexity) and to evaluate whether the Enhanced Recovery after Surgery (ERAS) protocol improves postoperative outcomes for each complexity grade. STUDY DESIGN: Consecutive patients undergoing open liver resection and laparoscopic liver resection at Lausanne University Hospital during 2010 to 2020 were assessed. RESULTS: A total of 437 patients were included. Operative time, estimated blood loss, and length of hospital stay increased significantly, with a stepwise increase of the grades from I to III in open liver resection and laparoscopic liver resection (all, p < 0.05). The same trend for Comprehensive Complication Index was found in open liver resection (p < 0.005). Age (p = 0.004), 3-level complexity classification (grade II vs I; p = 0.001; grade III vs I; p < 0.001), no use of the ERAS protocol (p = 0.016), and biliary reconstruction (p < 0.001) were significant predictors for postoperative complication, defined as Comprehensive Complication Index ≥ 26.2 in a multivariable logistic regression analysis. The prediction model incorporating the 4 factors had a calculated Concordance Index of 0.735 and 0.742 based on the bootstrapping method. The use of ERAS protocol was associated with lower probability of postoperative complication for each complexity grade and age. CONCLUSIONS: The use of ERAS protocol can decrease the probability of postoperative complication for each surgical complexity of liver resection and patient age. This finding emphasized the importance of tailoring perioperative management according to surgical complexity and patient age to improve outcomes after liver resection.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Hepatectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fatores Etários , Idoso , Área Sob a Curva , Ductos Biliares/cirurgia , Perda Sanguínea Cirúrgica , Feminino , Hepatectomia/classificação , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/prevenção & controle , Probabilidade , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Análise de Regressão , Resultado do Tratamento
18.
Surgery ; 170(5): 1310-1316, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34148708

RESUMO

BACKGROUND: After major bile duct injury, hepaticojejunostomy can result in good long-term patency, but anastomotic stricture is a common cause of long-term morbidity. There is a need to assimilate high-level evidence to establish risk factors for development of anastomotic stricture after hepaticojejunostomy for bile duct injury. METHODS: A systematic review of studies reporting the rate of anastomotic stricture after hepaticojejunostomy for bile duct injury was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses of proposed risk factors were then performed. RESULTS: Meta-analysis included 5 factors (n = 2,155 patients, 17 studies). Concomitant vascular injury (odds ratio 4.96; 95% confidence interval 1.92-12.86; P = .001), postrepair bile leak (odds ratio: 8.03; 95% confidence interval 2.04-31.71; P = .003), and repair by nonspecialist surgeon (odds ratio 11.29; 95% confidence interval 5.21-24.47; P < .0001) increased the rate of anastomotic stricture of hepaticojejunostomy after bile duct injury. Level of injury according to the Strasberg Grade did not significantly affect the rate of anastomotic stricture (odds ratio: 0.97; 95% confidence interval 0.45-2.10; P = .93). Owing to heterogeneity of reporting, it was not possible to perform a meta-analysis for the impact of timing of repair on anastomotic stricture rate. CONCLUSION: The only modifiable risk factor, repair by a nonspecialist surgeon, demonstrates the importance of broad awareness of these data. Knowledge of these risk factors may permit risk stratification of follow-up, better informed consent, and understanding of prognosis.


Assuntos
Doenças dos Ductos Biliares/cirurgia , Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Jejunostomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Anastomose Cirúrgica/efeitos adversos , Ductos Biliares/lesões , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Saúde Global , Humanos , Incidência , Complicações Pós-Operatórias/etiologia , Fatores de Risco
19.
AJR Am J Roentgenol ; 217(2): 426-432, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34076458

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the factors associated with local tumor progression (LTP) and overall survival (OS) in patients who have undergone percutaneous radiofrequency ablation (RFA) for recurrent intrahepatic cholangiocarcinoma (iCCA) after curative resection. MATERIALS AND METHODS. Data from 40 patients (mean age, 56.3 years) with 64 recurrent iCCAs (median diameter, 1.5 cm) who underwent percutaneous RFA between 1999 and 2019 were retrospectively analyzed. Patients were included if they had three or fewer metastases, a maximum tumor diameter of 5 cm or less, and disease confined to the liver. RESULTS. Technical success was achieved in all patients, with no procedure-related mortality. During follow-up, local progression of treated lesions was observed in 31.3% of tumors. The median OS and 5-year survival rate from initial RFA were 26.6 months and 18.3%, respectively. Multivariable analysis showed that a larger tumor diameter (> 2 cm, p = .004) was significantly associated with reduced LTP-free survival and that both a larger tumor diameter and less than 1 year from surgery to recurrence (p = .005 and .006, respectively) were statistically significant predictors of reduced OS after RFA. CONCLUSION. Percutaneous RFA may offer a well-tolerated and successful approach to local tumor control in patients with recurrent iCCA after curative surgery. Patients with a small-diameter tumor (≤ 2 cm) and late hepatic recurrence (≥ 1 year after curative resection) benefited most from RFA treatment.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Ablação por Radiofrequência/métodos , Adulto , Idoso , Ductos Biliares/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Resultado do Tratamento
20.
ANZ J Surg ; 91(7-8): 1542-1548, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34184389

RESUMO

BACKGROUND: Post-cholecystectomy bile duct injury (BDI) is a serious complication that often requires surgical repair. This study aimed to analyze the outcomes of surgery performed for BDI and to determine the factors associated with post-surgical complications. METHODS: A retrospective analysis was conducted using a prospectively maintained database of 105 patients who underwent surgical repair for post-cholecystectomy BDI between March 2013 and March 2020. BDI was classified based on the Strasberg-Bismuth system, and the outcomes were graded using the McDonald criteria. Multivariable logistic regression was used to identify the significant variables associated with postoperative complications. RESULTS: In a cohort of 105 patients with post-cholecystectomy BDI who underwent bilioenteric repair, 71 (67.6%), 25 (23.8%), 2 (1.9%), and 7 (6.7%) patients had excellent, good, fair, and poor outcomes, respectively, during a median follow-up of 64 months. The incidence of recurrent biliary stricture after definitive surgical hepaticojejunostomy was 6.7% (n = 7). The presence of cholangitis, choledochoduodenal fistula, and hilar biliary strictures was among the significant variables associated with the development of both short-term and long-term complications following surgery. CONCLUSIONS: Surgical repair of BDIs with bilioenteric anastomosis can yield excellent results when managed in a tertiary care center where expertise in the reconstruction of the biliary tree is prioritized.


Assuntos
Sistema Biliar , Colecistectomia Laparoscópica , Ductos Biliares/cirurgia , Colecistectomia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
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