The addition of simvastatin administration to cold storage solution of explanted whole liver grafts for facing ischemia/reperfusion injury in an area with a low rate of deceased donation: a monocentric randomized controlled double-blinded phase 2 study.

BACKGROUND: Liver transplantation is the best treatment for end-stage liver disease. The interruption of the blood supply to the donor liver during cold storage damages the liver, affecting how well the liver will function after transplant. The drug Simvastatin may help to protect donor livers against this damage and improve outcomes for transplant recipients. The aim of this study is to evaluate the benefits of treating the donor liver with Simvastatin compared with the standard transplant procedure. PATIENT AND METHODS: We propose a prospective, double-blinded, randomized phase 2 study of 2 parallel groups of eligible adult patients. We will compare 3-month, 6-month, and 12-month graft survival after LT, in order to identify a significant relation between the two homogenous groups of LT patients. The two groups only differ by the Simvastatin or placebo administration regimen while following the same procedure, with identical surgical instruments, and medical and nursing skilled staff. To reach these goals, we determined that we needed to recruit 106 patients. This sample size achieves 90% power to detect a difference of 14.6% between the two groups survival using a one-sided binomial test. DISCUSSION: This trial is designed to confirm the effectiveness of Simvastatin to protect healthy and steatotic livers undergoing cold storage and warm reperfusion before transplantation and to evaluate if the addition of Simvastatin translates into improved graft outcomes. TRIAL REGISTRATION: ISRCTN27083228

Case report: Trans-papillary free stenting of the cystic duct and of the common bile duct in a double biliary ducts anastomoses of a right lobe living donor transplantation

Background: One of the major issues related to the living donor liver transplantation recipient outcome is still the high rate of biliary complication, especially when multiple biliary ducts are present and multiple anastomoses have to be performed. Case presentation and conclusion: We report a case of adult-to-adult right lobe living donor liver transplantation performed for a recipient afected by alcohol-related cirrhosis with MELD score of 17. End-stage liver disease was complicated by refractory ascites, portal hypertension, small esophageal varices and portal gastropathy, hypersplenism, and abundant right pleural efusion. Here in the attached video we described the adult-to-adult LDLT procedures, where a right lobe with two biliary ducts draining respectively the right anterior and the right posterior segments has been transplanted. LDLT required a biliary reconstruction using the native cystic and common bile ducts stented trans-papillary with two 5- French 6 cm long soft silastic catheter. None major complications were detected during post-operative clinical courses. Actually, the donor and the recipient are alive and well. The technique we describe in the video, allow to keep the biliary anastomoses protected and patent without having the risk of creating cholestasis and the need of invasive additional procedure. No living donor right lobe transplantation should be refused because of the presence of multiple biliary ducts

Donor Simvastatin Treatment Is Safe and Might Improve Outcomes After Liver Transplantation: A Randomized Clinical Trial.

BACKGROUND The current curative approaches for ischemia/reperfusion injury on liver transplantation are still under debate for their safety and efficacy in patients with end-stage liver disease. We present the SIMVA statin donor treatment before Liver Transplants study. METHODS SIMVA statin donor treatment before Liver Transplants is a monocentric, double-blind, randomized, prospective tial aiming to compare the safety and efficacy of preoperative brain-dead donors' treatment with the intragastric administration of 80 mg of simvastatin on liver transplant recipient outcomes in a real-life setting. Primary aim was incidence of patient and graft survival at 90 and 180 d post-transplant; secondary end-points were severe complications. RESULTS The trial enrolled 58 adult patients (18-65 y old). The minimum follow-up was 6 mo. No patient or graft was lost at 90 or 180 d in the experimental group (n = 28), whereas patient/graft survival were 93.1% (P = 0.016) and 89.66% (P = 0.080) at 90 d and 86.21% (P = 0.041) and 86.2% (P = 0.041) at 180 d in the control group (n = 29). The percentage of patients with severe complications (Clavien-Dindo ≥IIIb) was higher in the control group, 55.2% versus 25.0% in the experimental group (P = 0.0307). The only significant difference in liver tests was a significantly higher gamma-glutamyl transferase and alkaline phosphatase at 15 d (P = 0.017), (P = 0.015) in the simvastatin group. CONCLUSIONS Donor simvastatin treatment is safe, and may significantly improve early graft and patient survival after liver transplantation, although further research is mandatory

Internal sphincterotomy reduces postoperative pain after Milligan Morgan haemorrhoidectomy

<p>Abstract</p> <p>Background</p> <p>Over the last few years, there has been increasing attention on surgical procedures to treat haemorrhoids. The Milligan-Morgan haemorrhoidectomy is still one of the most popular surgical treatments of haemorrhoids. The aim of the present work is to assess postoperative pain, together with other early and late complications, after Milligan-Morgan haemorrhoidectomy as we could observe in our experience before and after performing an internal sphincterotomy.</p> <p>Methods</p> <p>from January 1980 to May 2007, we operated 850 patients, but only 699 patients (median age 53) were included in the present study because they satisfied our inclusion criteria. The patients were divided into two groups: all the patients operated on before 1995 (group A); all the patients operated on after 1995 (group B). Since 1995 an internal sphincterotomy of about 1 cm has been performed at the end of the procedure. The data concerning the complications of these two groups were compared. All the patients received a check-up at one and six months after operation and a telephone questionnaire three years after operation to evalue medium and long term results.</p> <p>Results</p> <p>after one month 507 patients (72.5%) did not have any postoperative complication. Only 192 patients (27.46%) out of 699 presented postoperative complication and the most frequent one (23.03%) was pain. The number of patients who suffered from postoperative pain decreased significantly when performing internal sphincterotomy, going from 28.8% down to 10.45% (χ²: 10,880; p = 0,0001); 95% Confidence Interval (CI) 24.7 to 28.9 (group A) and 10.17 to 10.72 (group B). In 51 cases (7.29%) urinary retention was registered. Six cases of bleeding (0.85%) were registered. Medium and long term follow up did not show any difference among the two groups.</p> <p>Conclusion</p> <p>internal sphincterotomy: reduces significantly pain only in the first postoperative period, but not in the medium-long term follow up; does not increase the incidence of continence impairment when performed; does not influence the incidence of the other postoperative complications especially as regard medium and long term results.</p

Modificazioni dell’emodinamica splancnica dopo somministrazione endovenosa di terlipressina in associazione ad infusione di octreotide nel suino.

L’obiettivo di questo studio è valutare gli effetti sull’emodinamica splancnica dopo la somministrazione di terlipressina in associazione all’infusione endovenosa di octeotride. La terlipressina trova impiego clinico nella terapia selettiva delle emorragie da varici esofagee, principale complicanza dell’ipertensione portale, senza provocare alterazioni della dinamica emocoagulativa. L’uso dell’octreotide è ben conosciuto come valida terapia per emorragia delle varici in pazienti cirrotici attraverso la riduzione della pressione portale e il flusso sanguigno portocollaterale. Lo scopo del presente studio è valutare gli effetti dell’associazione farmacologica di terlipressina e octreotide nell’emodinamica epatica, attenzionando l’interazione tra il flusso portale e quello arterioso epatico nel maiale.The objective of this study was to evaluate the effects of splanchnic hemodynamics after administration of terlipressin in combination intravenous infusion of octreotide. Terlipressin is used clinically in the treatment of selective variceal bleeding, the main complication of portal hypertension, without causing any of the dynamics emocoagulativa. The use of octreotide is well known as an effective therapy for variceal bleeding in cirrhotic patients by reducing portal pressure and blood flow portocollaterale. The purpose of this study was to evaluate the pharmacological effects of the association of terlipressin and octreotide in hemodynamics of the liver, with particular attention to the interaction between the hepatic arterial and portal flow in the pig

Emoperitoneo da rottura di ematoma subcapsulare epatico indotto dal ketorolac dopo colecistectomia laparoscopica. Caso clinico

Il ketorolac è uno dei più comuni antinfiammatori non steroidei usati per il dolore postoperatorio. Diversi studi hanno messo in evidenza come la somministrazione perioperatoria e postoperatoria del ketorolac sia associata ad un aumentato rischio di sanguinamento. Questa evenienza, pur non essendo frequente, può esporre il paziente a gravi complicanze postoperatorie che devono essere conosciute per poter essere trattate tempestivamente ed efficacemente. Presentiamo il caso di una nostra paziente che, affetta da colelitiasi,è stata sottoposta a colecistectomia videolaparoscopica in elezione sviluppando, nell’immediato postoperatorio, un’emorragia in un primo momento attribuita all’atto chirurgico ed in seguito alla somministrazione di ketorolac

Giant Complicated Hydatid Cyst Of The Liver And Occult Duodenal Adenocarcinoma: A Case Report.

We present an original article about an interesting and challenging case: a patient with abdominal discomfort, dyspepsia due to a giant hydatid cyst of the liver causing obstruction of upper digestive canal, reduction of hepatic function, hepatomegaly and hiding an occult duodenal adenocarcinoma marked by a very fast evolution