15 research outputs found
Association between biliary complications and technique of hilar division (extrahepatic vs. intrahepatic) in major liver resections
BACKGROUND: Division of major vascular and biliary structures during major hepatectomies can be carried out either extrahepatically at the porta hepatic or intrahepatically during the parenchymal transection. In this retrospective study we test the hypothesis that the intrahepatic technique is associated with less early biliary complications. METHODS: 150 patients who underwent major hepatectomies were retrospectively allocated into an intrahepatic group (n = 100) and an extrahepatic group (n = 50) based on the technique of hilar division. The two groups were operated by two different surgical teams, each one favoring one of the two approaches for hilar dissection. Operative data (warm ischemic time, operative time, blood loss), biliary complications, morbidity and mortality rates were analyzed. RESULTS: In extrahepatic patients, operative time was longer (245 ± 50 vs 214 ± 38 min, p < 0.05) while the overall complication rate (55% vs 52%), hospital stay (13 ± 7 vs 12 ± 4 days), bile leak rate (22% vs 20%) and mortality (2% vs 2%) were similar compared to intrahepatic patients. However, most (57%) bile leaks in extrahepatic patients were grade II (leaks that required non-operative interventional treatment, while most (70%) leaks in the intrahepatic group were grade I (leaks that resolved and presented two injuries (4%) of the remaining bile ducts (p < 0.05). CONCLUSION: Intrahepatic hilar division is as safe as extrahepatic hilar division in terms of intraoperative blood requirements, morbidity and mortality. The extrahepatic technique is associated with more severe bile leaks and biliary injuries
IVC CLAMP: infrahepatic inferior vena cava clamping during hepatectomy - a randomised controlled trial in an interdisciplinary setting
<p>Abstract</p> <p>Background</p> <p>Intraoperative haemorrhage is a known predictor for perioperative outcome of patients undergoing hepatic resection. While anaesthesiological lowering of central venous pressure (CVP) by fluid restriction is known to reduce bleeding during transection of the hepatic parenchyma its potential side effects remain poorly investigated. In theory it may have negative effects on kidney function and tissue perfusion and bears the risk to result in severe haemodynamic instability in case of profound intraoperative blood loss. The present randomised controlled trial evaluates efficacy and safety of infrahepatic inferior vena cava (IVC) clamping as an alternative surgical technique to reduce CVP during hepatic resection.</p> <p>Methods/Design</p> <p>The proposed IVC CLAMP trial is a single-centre randomised controlled trial with a two-group parallel design. Patients and outcome-assessors are blinded for the treatment intervention. Patients undergoing elective hepatic resection due to any reason are enrolled in IVC CLAMP. All patients admitted to the Department of General-, Visceral-, and Transplant Surgery, University of Heidelberg for elective hepatic resection are consecutively screened for eligibility and written informed consent is obtained on the day before surgery. The primary objective of this trial is to assess and compare the amount of blood loss during hepatic resection in patients receiving surgical CVP reduction by clamping of the IVC as compared to anaesthesiological CVP without infrahepatic IVC clamping reduction. In addition to blood loss a set of general as well as surgical variables are analysed.</p> <p>Discussion</p> <p>This is a randomised controlled patient and observer blinded two-group parallel trial designed to assess efficacy and safety of infrahepatic IVC clamping during elective hepatectomy.</p> <p>Trial registration</p> <p>ClinicalTrials NCT00732979</p
Large lipoma of the vulva
Vulvar lipoma is a rare entity. A 52-year-old woman presented with a
large mass arising in the right major labium. CT scan revealed that the
mass contained adipose tissue. During operation a lipomatous tumor was
found which at histologic examination proved to be a lipoma. (C) 1999
Elsevier Science Ireland Ltd. All rights reserved
Transthoracic versus transabdominal surgical approach for echinococcal cysts located over the superoposterior aspect of the right lobe of the liver
A retrospective study of 80 patients operated on for hydatid cysts
located on the superoposterior aspect of the right lobe of the liver
(segments VI, VII, VIII) is presented. Right thoracotomy was performed
in 30 patients, and 50 patients were operated on through bilateral
subcostal incisions. The two approaches were compared in terms of
radicality and morbidity. The transabdominal approach produced superior
results and fewer postoperative complications, resulting in a shorter
hospital stay (11 +/- 5 vs. 18 +/- 8 days). Total cystopericystectomy
was feasible in 30% of patients operated on transabdominally and in 6%
of those approached transthoracically. The rest of the patients were
offered partial pericystectomy, except three in the thoracotomy group
who underwent simple drainage of the cavity. We recommend that the
transabdominal approach be the first choice for treatment of liver
hydatid cysts irrespective of their location and size. We abandoned the
transthoracic approach for cysts located on the superoposterior aspect
of the right liver lobe in 1996. The transabdominal approach enables the
surgeon to treat liver hydatidosis in a more radical, safer manner than
does the transthoracic approach
Total versus selective hepatic vascular exclusion in major liver resections
Background: Total hepatic vascular exclusion (THVE) and selective
hepatic vascular exclusion (SHVE) are two effective techniques for
bleeding control in major hepatic resections. Outcomes of the two
procedures were compared.
Methods: Patients undergoing major liver resection were randomly
allocated to the THVE and SHVE groups. Intraoperative hemodynamic
changes and the postoperative course of the two groups were compared.
Results: During vascular clamping, the THVE group showed a significant
elevation in pulmonary vascular resistance, systemic vascular
resistance. intrapulmonary shunts, and a significant reduction in
cardiac index, compared with the SHVE group (P <0.05). Patients
undergoing THVE received more crystalloids and blood, showed more severe
liver, renal and pancreatic dysfunction, and had a longer hospital stay
than the SHVE group (P <0.05).
Conclusions: Both techniques are equally effective in bleeding control
in major liver resections. THVE is associated with cardiorespiratory and
hemodynamic alterations and may be not tolerated by some patients. SHVE
is well tolerated with fewer postoperative complications and shorter
hospitalization time. (C) 2002 Excerpta Medica, Inc. All rights
reserved
Effect of mesocaval shunt on survival of small-for-size liver grafts: Experimental study in pigs
Segmental liver grafts with a calculated ideal liver weight (CILW) less
than 40% may be associated with portal flow-related injuries and
primary dysfunction. This study evaluated the effect of mesocaval shunts
on the survival of grafts with a CILW less than 20%. Sixteen pigs
underwent orthotopic transplantation of segmental liver grafts with a
CILW less than 20%. In eight animals (study group), transplantation was
combined with a mesocaval shunt, and eight animals served as controls
without a mesocaval shunt. Liver function, systemic hemodynamics, portal
vein pressure, intracranial pressure, and cerebral perfusion pressure
were assessed postoperatively. The controls showed a rapid impairment of
liver function reflected by a significant elevation in aspartate
aminotransferase, international normalized ratio, bilirubin, and
intracranial pressure and a decrease in cerebral perfusion pressure
compared with the study group (P<0.05). Mesocaval shunts showed
protective effects on grafts with CILW less than 20% and may have a
clinical role in the salvage of small-for-size liver grafts
Selective hepatic vascular exclusion versus pringle maneuver in major liver resections: Prospective study
Selective hepatic vascular exclusion (SHVE) and the Pringle maneuver are
two methods used to control bleeding during hepatectomy. They are
compared in a prospective randomized study, where 110 patients
undergoing major liver resection were randomly allocated to the SHVE
group or the Pringle group. Data regarding the intraoperative and
postoperative courses of the patients are analyzed. Intraoperative blood
loss and transfusion requirements were significantly decreased in the
SHVE group, and postoperative liver function was better in that group.
Although there was no difference between the two groups regarding the
postoperative complications rate, patients offered the Pringle maneuver
had a significantly longer hospital stay. The application of SHVE did
not prolong the warm ischemia time or the total operating time. It is
evident from the present study that SHVE performed by experienced
surgeons is as safe as the Pringle maneuver and is well tolerated by the
patients. It is much more effective than the Pringle maneuver for
controlling intraoperative bleeding, and it is associated with better
postoperative liver function and shorter hospital stay