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1.
World J Surg ; 44(11): 3868-3874, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32591841

RESUMO

BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.


Assuntos
Laparoscopia , Neoplasias Hepáticas , Argentina , Ásia , Brasil , Chile , Colômbia , Europa (Continente) , Hepatectomia , Humanos , Fígado , Neoplasias Hepáticas/cirurgia , Peru
2.
Br J Surg ; 101(6): 677-84, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24664658

RESUMO

BACKGROUND: The role of intraoperative cholangiography (IOC) in the diagnosis, prevention and management of bile duct injury (BDI) remains controversial. The aim of the present study was to determine the value of routine IOC in the diagnosis and management of BDI sustained during laparoscopic cholecystectomy (LC) at a high-volume centre. METHODS: A retrospective analysis of a single-institution database was performed. Patients who underwent LC with routine IOC between October 1991 and May 2012 were included. RESULTS: Among 11,423 consecutive LCs IOC was performed successfully in 95.7 per cent of patients. No patient had IOC-related complications. Twenty patients (0.17 per cent) sustained a BDI during LC, and the diagnosis was made during surgery in 18 patients. Most BDIs were type D according to the Strasberg classification. The sensitivity of IOC for the detection of BDI was 79 per cent; specificity was 100 per cent. All injuries diagnosed during surgery were repaired during the same surgical procedure. Two patients developed early biliary strictures that were treated by percutaneous dilatation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results. CONCLUSION: The routine use of IOC during LC in a high-volume teaching centre was associated with a low incidence of BDI, and facilitated detection and repair during the same surgical procedure with a good outcome.


Assuntos
Ductos Biliares/lesões , Colangiografia/métodos , Colecistectomia Laparoscópica/efeitos adversos , Complicações Intraoperatórias/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Biliares/cirurgia , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
3.
Int J Organ Transplant Med ; 13(2): 30-35, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-37641732

RESUMO

Background: Liver re-transplantation (re-LT) represents the only treatment for patients with irreversible graft failure. Objective: The aim of the current study was to describe the outcomes of both, patient and graft, after re- LT, at a high-volume referral center. Methods: Our population consisted of patients, with liver disease, who underwent re-LT in our institution between January 1996 and December 2019. Results: 49 patients met the inclusion criteria. The patient's overall survival (OS) for the first year was 85% (Confidence Intervals (CI) 71-92) and 70% at five years (CI 53-82). In our population, three (6.12%) patients presented loss of graft and were included again in the transplant list; of these, one agreed to a new transplant while the remaining two died. This gave us graft survival results similar to those obtained for the re-LT patient; 85% at one year (CI 71-92) and 70% at 5 years (CI 53-82). Conclusion: Our study shows that re-LT is a valid and safe treatment for both early graft dysfunction and for transplanted patients who again present end-stage liver disease, showing a satisfactory long-term evolution, with parameters comparable to primary transplantation.

4.
Ann R Coll Surg Engl ; 103(8): e266-e268, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464569

RESUMO

Haemorrhagic events in patients diagnosed with coronavirus disease 19 (COVID-19) are infrequent but reports have accumulated since the beginning of the pandemic. The pathophysiological mechanisms are unclear, but endothelial damage secondary to systemic vasculitis and the onset of anticoagulation therapy, both associated with severe forms of the infection, have been proposed to play a role in the development of this complication. We present the case of a 66-year-old man who presented to the emergency department with acute abdominal pain, hypotension and decrease of consciousness, a few hours after being discharged after a prolonged hospitalisation of 26 days due to severe SARS-CoV-2 pneumonia. Initial resuscitation was carried out and, when haemodynamic stabilisation was achieved, a computed tomography scan showed contrast extravasation at the topography of the greater omentum. Urgent angiography revealing contrast extravasation originating in a pseudoaneurysm dependent on the right gastroepiploic artery was done, and embolisation with cyanoacrylate was performed at the bleeding point. Owing to persistent haemodynamic instability despite angiographic treatment and aggressive resuscitation, emergency laparotomy was indicated. Partial resection of the greater omentum was carried out and histopathologic examination showed a 5cm×4cm×6cm haematoma, with no signs of abnormalities such as aneurysm or malignancy. No rebleeding occurred. Spontaneous haemorrhage of the greater omentum associated with haemoperitoneum is a serious condition, with reported mortality rates exceeding 30%. This case highlights a very infrequent but potentially life-threatening complication in a patient diagnosed with COVID-19 on anticoagulation therapy.


Assuntos
COVID-19/complicações , Hemoperitônio/etiologia , Hemorragia/virologia , Omento/cirurgia , Doenças Peritoneais/virologia , Idoso , Hemoperitônio/cirurgia , Hemorragia/cirurgia , Humanos , Masculino , Doenças Peritoneais/cirurgia
5.
Surg Endosc ; 20(11): 1648-53, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17063285

RESUMO

BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. In the current study, this approach was associated with a higher incidence of biliary injuries. The authors evaluate their experience treating complex biliary injuries and analyze the literature. METHODS: In a 15-year period, 169 patients with bile duct injuries (BDIs) resulting from open and laparoscopic cholecystectomies were treated. The patients were retrospectively evaluated through their records. Biliary injury and associated lesions were evaluated with imaging studies. Surgical management included therapeutic endoscopy, percutaneous interventions, hepaticojejunostomy, liver resection, and liver transplantation. Postoperative outcome was recorded. Survival analysis was performed with G-Stat and NCSS programs using the Kaplan-Meier method. RESULTS: Of the 169 patients treated for BDIs, 148 were referred from other centers. The injuries included 115 lesions resulting from open cholecystectomy and 54 lesions resulting from laparoscopic cholecystectomy. A total of 110 patients (65%) fulfilled the criteria for complex injuries, 11 of whom met more than one criteria. Injuries resulting from laparoscopic and open cholecystectomies were complex in 87.5% and 72% of the patients, respectively. The procedures used were percutaneous transhepatic biliary drainage for 30 patients, hepaticojejunostomy for 96 patients, rehepaticojejunostomy for 16 patients, hepatic resection for 9 patients, and liver transplantation projected for 18 patients. Hepaticojejunostomy was effective for 85% of the patients. The mean follow-up period was 77.8 months (range, 4-168 months). The mortality rate for noncomplex BDI was 0%, as compared with the mortality rate of 7.2% (8/110) for complex BDI. Mortality after hepatic resection was nil, and morbidity was 33.3%. The actuarial survival rate for liver transplantation at 1 year was 91.7%. CONCLUSIONS: Complex BDIs after laparoscopic cholecystectomy are potentially life-threatening complications. In this study, late complications of complex BDIs appeared when there was a delay in referral or the patient received multiple procedures. On occasion, hepatic resections and liver transplantation proved to be the only definitive treatments with good long-term outcomes and quality of life.


Assuntos
Doenças dos Ductos Biliares/cirurgia , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Adolescente , Adulto , Idoso , Doenças dos Ductos Biliares/etiologia , Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar , Criança , Colecistectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
6.
Ann Chir ; 128(3): 188-90, 2003 Apr.
Artigo em Francês | MEDLINE | ID: mdl-12821089

RESUMO

Biliary papillomatosis is a uncommon disease. Because of the high rate of recurrence and the possibility of malignant transformation, liver resection or transplantation was recommended. A case of diffuse bilobar biliary papillomatosis, in a 60 years old patient, responsible for cholangitis, cholestasis and for high portal pressure (esophageal varices grade I and II and hypersplenisme) is reported. The patient had had an external biliary drainage leading to an great loss of hydroelectrolytic component important. Opacification and biopsies under endoscopic control assert the right diagnosis. He was treated by a orthotopic liver transplantation. Post operative course was simple. In the 9th month, it was asymptomatic with a completely satisfactory evolution. The other therapeutic modalities was discussed, as well as the review of the literature.


Assuntos
Neoplasias do Sistema Biliar/cirurgia , Transplante de Fígado , Papiloma/cirurgia , Seleção de Pacientes , Neoplasias do Sistema Biliar/complicações , Neoplasias do Sistema Biliar/diagnóstico , Biópsia , Colangiografia , Colangite/etiologia , Colestase/etiologia , Varizes Esofágicas e Gástricas/etiologia , Hepatectomia , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Pancreaticoduodenectomia , Papiloma/complicações , Papiloma/diagnóstico , Resultado do Tratamento
7.
Medicina (B Aires) ; 59(6): 685-92, 1999.
Artigo em Espanhol | MEDLINE | ID: mdl-10752209

RESUMO

After more than 10,000 cases reported all over the world until 1998, simultaneous kidney and pancreas transplantation has become a safe clinical practice, and it may probably represent the best treatment available for diabetic patients in end-stage renal disease. Here we present our results after 12 cadaveric pancreas transplants (8 whole organ, and 4 islet transplants), performed on insulin-dependent diabetic patients. Eleven of these patients received a kidney simultaneously, and one of them required a kidney retransplantation. All vascularised pancreatic grafts were positioned intraperitoneally, anastomosed to the iliac vessels, and bladder drained. One year patient, whole pancreas, and kidney survival rates were 86%, 86% and 71%, respectively. All of these patients remain insulin and dialysis-free, the longest for 37 months. Islets for transplantation were obtained from single cadaveric donors. Fresh, unpurified cells were transplanted intraperitoneally by laparoscopy (equivalent islet yields: 3 x 10(5), 4 x 10(5), 1 x 10(6) and 5 x 10(5)). None of the islet recipients resulted insulin-independent but they all reduced daily requirements in about 40%, with better metabolic control (mean HbA1c pretransplant 9.4 +/- 1.8, vs 7.9 +/- 1.6 posttransplant). One kidney graft was lost due to venous thrombosis. Simultaneous kidney and pancreas transplantation offers the diabetic patient in end-stage renal disease a chance of independence both from dialysis and exogenous insulin. Whole pancreas transplantation has better functional outcome than islet transplantation. Nevertheless, for those diabetic patients who do not meet the criteria to receive a vascularised graft, pancreatic cells may still improve carbohydrate metabolism with minor surgical risk.


Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Transplante das Ilhotas Pancreáticas , Transplante de Rim , Transplante de Pâncreas , Adulto , Argentina , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
8.
Acta Gastroenterol Latinoam ; 26(1): 7-13, 1996.
Artigo em Espanhol | MEDLINE | ID: mdl-9137651

RESUMO

Image-guided percutaneous transhepatic cholecystostomy (PTC) was suspected Acute Acalculous Cholecystitis (AAC). Seven of them developed AAC at home while eight patients developed the disease while hospitalized by critical illness. We performed PTC with Seldinger technique, guided: 13 by US CT. In every cases the catheter was placed successfully AAC was confirmed in 14/15 patients. No severe complications were related to the procedure. All but 3 improved following PTC: 2 required cholecystectomy because of diffuse gallbladder gangrene and one died by sepsis 48 hs after PTC. Light complications were: 1 homobilia and fever by 36 hs. In this series mobility was 35% and mortality 21%. Thus 9 patients with AAC were cured with PTC and are alive and symptom-free without surgery. PTC failed in 3/14 patients and other 2 died by causes unrelated to biliary disease. We conclude that PTC is a safe and effective temporary method for definitive treatment of AAC. Surgery is limited to that cases with generalized peritonitis and those when PTC has fallen.


Assuntos
Colecistite/cirurgia , Colecistostomia/métodos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiografia , Colecistite/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Acta Gastroenterol Latinoam ; 31(5): 367-75, 2001.
Artigo em Espanhol | MEDLINE | ID: mdl-11873663

RESUMO

BACKGROUND: Several options now available create the need for a multidisciplinary approach to the treatment of patients with hepatocellular carcinoma (HCC). OBJECTIVE: To describe the experience with a group of patients with HCC diagnosed and treated with the current modalities for control of this entity. POPULATION AND METHOD: A total of 169 consecutive patients with HCC treated between January 1990 and February 1998; 41 liver resections, 14 liver transplants, 87 chemoembolizations and 8 alcoholizations were performed. The median follow-up time was 23.6 months (range: 0.2-94). In the other 29 patients, only support treatment was administered. RESULTS: Resected patients had a lower median hospitalization rate, blood transfusions, and hospitalization mortality. Recurrence was 42.1% in the resected group but 0% in transplanted patients. The overall survival at 36 months was better for transplanted than for resected patients (100% vs. 62.3%; p < 0.02). The median survival time was 13 months (IC: 95%: 11-15 months) in chemoembolizated patients. CONCLUSIONS: 1. The outcome of patients with HCC is influenced by several factors, therefore calling for multimodal approach. 2. Surgical procedures should be indicated with low morbimortality rates. 3. The overall survival and disease free survival time is better in transplanted patients than in the resected group. 4. The survival time of patients with unresectable HCC without extra-liver disease could be improved with chemoembolization.


Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Adolescente , Adulto , Idoso , Carcinoma Hepatocelular/cirurgia , Quimioembolização Terapêutica , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
15.
HPB (Oxford) ; 10(1): 4-12, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18695753

RESUMO

BACKGROUND: Laparoscopic cholecystectomy is the present treatment of choice for patients with gallbladder stones, despite its being associated with a higher incidence of biliary injuries compared with the open procedure. Injuries occurring during the laparoscopic approach seem to be more complex. A complex biliary injury is a disease that is difficult to diagnose and treat. We considered complex injuries: 1) injuries that involve the confluence; 2) injuries in which repair attempts have failed; 3) any bile duct injury associated with a vascular injury; 4) or any biliary injury in association with portal hypertension or secondary biliary cirrhosis. The present review is an evaluation of our experience in the treatment of these complex biliary injuries and an analysis of the international literature on the management of patients.

16.
HPB (Oxford) ; 9(6): 435-9, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18345290

RESUMO

BACKGROUND AND AIM: Resection of colorectal liver metastases has become a standard of care, although the value of this procedure in non-colorectal non-neuroendocrine (NCRNNE) metastases remains controversial and is still a matter of debate. The aim of the study was to determine the utility of liver resection in the long-term outcome of patients with NCRNNE metastases. MATERIAL AND METHODS: The records of 106 patients who underwent liver resection for NCRNNE metastases in the period 1989 to 2006 at 5 HPB Centers in Argentina were analyzed. Patient demographics, tumor characteristics, type of resection, long-term outcome and prognostic factors were analyzed. Depending on primary tumor sites, a comparative analysis of survival was performed. RESULTS: Mean age was 54 (17-76). Hepatic metastases were solitary in 62.3% and unilateral in 85.6%. Primary tumor sites: Urogenital (37.7%), sarcomas (21.7%), breast (17.9%), gastrointestinal (6.6%), melanoma (5.7%), and others (10.4%). Fifty-one major hepatectomies and 55 minor resections were performed. Twenty patients underwent synchronous resections. An R0 resection could be achieved in 89.6%. Perioperative mortality was 1.8%. Overall, 1-year, 3-year, and 5-year survival rates were 67%, 34%, and 19%, respectively. Survival was significantly longer for metastases of urogenital (p=0.0001) and breast (p=0.003) origin. Curative resections (p=0.04) and metachronous disease (p=0.0001) were predictors of better survival. CONCLUSIONS: Liver resection is an effective treatment for NCRNNE liver metastases; it gives satisfactory long-term survival especially in metachronous disease, in patients with metastases from urogenital and breast tumors and when R0 procedures can be performed.

17.
Rev Med Chil ; 124(2): 225-30, 1996 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-9213892

RESUMO

In a family composed by eight brothers, five had a type I glycogen storage disease and three presented with liver tumors complicated with hemorrhage or malignant transformation, during the follow up. The periodic ultrasonographic control allowed the early diagnosis of these neoplasms. We describe the clinical picture and treatment of two patients. Metabolic alterations were corrected during the preoperative period with parenteral nutrition. Resection was successful in both cases. It is concluded that a close follow up and early treatment of these lesions is effective and avoids complications. In patients with multiple lesions and severe metabolic alterations, liver transplantation is the treatment of choice.


Assuntos
Doença de Depósito de Glicogênio Tipo I/complicações , Neoplasias Hepáticas/etiologia , Adulto , Feminino , Doença de Depósito de Glicogênio Tipo I/genética , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/terapia , Masculino , Linhagem
18.
Liver Transpl ; 6(1): 108-12, 2000 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10648588

RESUMO

A shortage of liver donors for low-weight transplant recipients has prompted the development of procedures for liver-reduction, split-liver, and living related donor transplantations. For pediatric recipients weighing less than 10 kg, the left lateral segment is often still too large. We describe the procedure of monosegmental transplantation using segment II after segment III was resected in situ from a living related donor. Successful monosegmental transplantation is technically feasible and is a valid alternative to be considered for cases of size discrepancy between the recipient's volume and the donor's left lateral segment.


Assuntos
Transplante de Fígado , Doadores Vivos , Adulto , Atresia Biliar/cirurgia , Estudos de Viabilidade , Feminino , Hepatectomia/métodos , Humanos , Lactente , Transplante de Fígado/métodos , Masculino , Complicações Pós-Operatórias
19.
HPB (Oxford) ; 4(3): 111-5, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-18332936

RESUMO

BACKGROUND: Intra-operative bile duct injuries (IBDI) are potentially severe complications of the treatment of benign conditions, with unpredictable long-term results. Multiple procedures are frequently needed to correct these complications. In spite of the application of these procedures, patients with severe injuries can develop irreversible liver disease. Liver transplantation (LT) is currently the only treatment available for such patients, but little information has been published concerning the results of LT. METHODS: Eight patients with LT for end-stage liver disease for IBDI were studied retrospectively. They had failure of multiple previous treatments and experienced recurrent episodes of cholangitis, oesophageal variceal bleeding, severe pruritus, refractory ascites and spontaneous peritonitis. RESULTS: Mean recipient hepatectomy time was of 243 minutes (range 140-295 min), the complete procedure averages 545 minutes (260-720) and intraoperative red-blood-cells consumption was 6.5 units (1-7). One patient required reoperation due to perforation of a Roux-en-Y loop, and three developed minor complications (2 wound infections, I inguinal lymphocele). One patient died due to nosocomial pneumonia (mortality rate 12.5%). One patient required retransplantation due to delayed hepatic artery thrombosis. At follow-up 75% of patients are alive with normal graft function and an excellent quality of life. CONCLUSIONS: LT represents a safe curative treatment for end-stage liver disease after IBDI, albeit a major undertaking in the context of a surgical complication in the treatment of benign disease. The complications of the surgical procedure and the long-standing immunosuppression impart a high cost for resolutions of these sequelae but LT represents the only long-term effective treatment for these selected patients.

20.
Lupus ; 12(2): 140-3, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12630760

RESUMO

Catastrophic antiphospholipid syndrome (CAPS) is an acutely devastating situation characterized by widespread thrombotic microangiopathy in the presence of elevated titers of antiphospholipid antibodies. We describe a 57-year old woman who underwent liver transplantation for primary sclerosing cholangitis and developed this malignant variant of the antiphospholipid syndrome.


Assuntos
Síndrome Antifosfolipídica/etiologia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias , Colangite Esclerosante/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade
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