Is it more dangerous to perform inadequate packing?

Peri-hepatic packing procedure, which is the basic damage control technique for the treatment of hepatic hemorrhage, is one of the cornerstones of the surgical strategy for abdominal trauma. The purpose of this study was to evaluate the efficacy of the perihepatic packing procedure by comparing the outcomes of appropriately and inappropriately performed interventions. Trauma patients with liver injury were retrospectively evaluated. The patients who had undergone adequate packing were classified as Group A, and the patients who had undergone inappropriate packing, as Group B. Over a five-year period, nineteen patients underwent perihepatic packing. Thirteen of these patients were referred by other hospitals. Of 13 patients, 9 with inappropriate packing procedure due to insertion of intraabdominal drainage catheter (n=4) and underpacking (n=5) were evaluated in Group B, and the others (n=10) with adequate packing were assessed in Group A. Mean 3 units of blood were transfused in Group A and unpacking procedure was performed in the 24th hour. Only 3 (30%) patients required segment resection with homeostasis, and the mortality rate was 20% (2/10 patients). In Group B, 4 patients required repacking in the first 6 hrs. Mean 8 units of blood were transfused until unpacking procedure. The mortality rate was 44% (4/9 patients). The length of intensive care unit stay and requirement of blood transfusion were statistically significantly lower in Group A (p < 0.05). The mortality rate of this group was also lower. However, the difference between the groups for mortality rates was not statistically significant. This study emphasizes that efficacy of the procedure is one of the determinants that affects the results, and inadequate or inappropriate packing may easily result in poor outcome

A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare

Ratlarda oluşturulan deneysel kolit modelinde kalsiyum kanal blokerlerinin etkileri

Daha önceden literatürde gerek Diltizem gerekse de Verapamil için kolit modelinde etkiler tartışılmıştır. Ancak bu birbirinden farklı mekanizmalar ile kalsiyum blokajı oluşturan Kalsiyum kanal blokerlerinin karşılaştırmalı değerlendirilmesi yapılmamıştır. Kardiolojik ve farmakolojik açıdan farklı endikasyon ve etkinlik grupları bilinen bu iki kalsiyum kanal blokerinin de kolit üzerindeki etkisini intrasellüler Ca** blokajı ile enflamatuar kaskat üzerine gösterdiği ve istatiksel olarak ortaya konulamasa da Verapamil etkinliğinin Diltiazem grubuna göre rölatif olarak avantaj sağladığı yorumu getirilebilinir. Ayrıca daha önceden literatürde soru olarak kalan kalsiyum kanal blokajının lokal olarak uygulanması ile sistemik yanıtta alınan cevaba benzer etki potansiyelinin ortaya çıkmış olması kalsiyum kanal bokerleri üzerinde daha yoğun ilgiyi toplayacağını ummaktayız. ÖZET Birçok tedavi rejimi elde olan silahların özelliklerinin yeniden keşfedilmesi ile ortaya çıkmaktadır. Aynı şekilde birçok hastalıkta tedavilerin çoğunlukla temel birimler ile ilgili çalışmalardan ortaya çıktığı ve çıkacağı unutulmamalıdır. Enflamatuar barsak hastalığına bugün için literatürdeki "Science Citation Index"e dahil dokuz milyon yayından bir milyon sekizyûzbininin ayrılması bu konu üzerinde ne kadar yoğunlaşıldığrmn bir göstergesidir. Bugün için etyolojik pekçok etmen tartışılırken, gelişim gösteren etyolojik tartışma platformu tedavi rejimlerinde de yeni yelpazeler sunmaktadır. Kalsiyum kanal blokajının gastroenteroloji pratiğindeki yeri, bu ilaçların özellikleri öğrenildikçe daha fazla yer tutacaktır. Özellikle motilite ve çahşmamızda da ortaya koyduğumuz gibi anti-enfiamatuar yanıt üzerine olan bu etkileri, enflamatuar barsak hastalığı gibi ciddi bir sağlık problemi olan konuya yeni bir bakış getirmesini sağlayacaktır. 5

Microvascular reconstruction of hepatic artery: Personal experience on 300 cases.

13th Annual Congress of the International-Liver-Transplantation-Society -- JUN 20-23, 2007 -- Rio de Janeiro, BRAZILWOS: 00024708470035

Effects of bile on arterial anastomosis in a rat model

Objective: Liver transplantation has been one of the areas in which microvascular surgery is frequently practiced. With the use of microsurgical techniques in hepatic artery anastomosis, the incidence of hepatic artery thrombosis has been signifi- cantly reduced. Hepatic artery anastomosis is realized after the anastomoses of the hepatic vessel and portal vessel are completed, and clamps are removed; in other words, after hepatic circulation starts. During hepatic artery anastomosis, bile runs towards the hepatic artery anastomosis line. This study aimed to investigate effects of bile on arterial anastomosis. Materials and Methods: Forty male Sprague Dawley rats were randomly divided into 2 groups. Femoral artery anasto- mosis was performed in rats of the control group (n = 20) through heparinized serum (10 U/ml) irrigation. In the rats of the study group (n = 20), however, femoral artery anastomosis was performed through heparinized serum (10 U/ml)+0.5 cc bile irrigation. After the 1st week, anastomosis patency was evaluated with color duplex ultrasonography. A 1 cm segment of the femoral artery involving the anastomosis line was removed for histopathological evaluation. Results: In the control group, no flow to the distal was observed in one anastomosis. All the anastomoses in the study group were patent. Histopathologically, perivascular polymorphonuclear leucocyte infiltration was observed in the study group. No statistically significant differences were observed for endothelial continuity and intimal thickening, and no statisti- cally significant differences were observed for anastomosis patency. Conclusions: In the light of these findings, it was determined that bile contamination did not have any negative or positive effects on artery anastomosis. [Arch Clin Exp Surg 2015; 4(3.000): 135-141

MICROVASCULAR RECONSTRUCTION OF HEPATIC ARTERY: PERSONAL EXPERIENCE ON 500 CASES

15th Annual Congress of the International-Liver-Transplantation-Society -- JUL 08-11, 2009 -- New York, NYWOS: 000267792300512Int Liver Transplantat So

Bimanual ‘bi-finger’ liver hanging maneuver: an alternative and safe technique for liver hanging

Background. Currently, a popular method for right hepatectomy is hepatic resection with the liver hanging maneuver. The aim of this study is to present an alternative and safe approach during this maneuver without using any instrument, thus avoiding injury. Patients and methods. From March 2005 to April 2006, a bimanual ‘bi-finger’ liver hanging maneuver (BBLHM) was planned in 22 right hepatectomies and the data were collected prospectively after operation. Results. BBLHM was performed in 21/22 patients (95%). The maneuver was stopped in one patient, due to manual detection of an accessory hepatic vein during finger dissection in the retrohepatic space. This vein did not allow completion of the BBLHM. The indications for right hepatectomy included 11 primary hepatic tumors (52%), 8 metastatic right hepatic tumors (38%), and 2 hydatid cysts (9%). Intraoperative ultrasound (IOUS) demonstrated the normal anatomical configuration type of the hepatic veins. Bleeding occurred in one patient (4%), which was interrupted with the use of continuous 6/0 polypropylene suture. Discussion. The most important step during the liver hanging maneuver is to develop the avascular space without any complication. In the present study, the index fingers were used instead of forceps during the blind dissection. BBLHM not only reduced the rate of damage to the hepatic veins but was also predictive for the presence of any accessory vein by its manual detection prior to injury. This maneuver allowed easier clamping of the hepatic veins and controllable hepatic resection. Dissection of retrohepatic space with the BBLHM produces a safer method, using both index fingers instead of a surgical instrument

Adefovir dipivoxil therapy in liver transplant recipients for recurrence of hepatitis B virus infection despite lamivudine plus hepatitis B immunoglobulin prophylaxis

WOS: 000251194500017PubMed ID: 18031370Background and Aim: Treatment of post-transplantation recurrence of hepatitis B virus (HBV) infection despite prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine combination therapy is not easy. Because HBV reinfection has a severe course and could result in graft failure in liver transplant recipients, prompt medication is essential. Herein is reported the authors' experience with adefovir dipivoxil (AD) therapy in 11 liver transplant recipients who had HBV reinfection despite the administration of lamivudine and HBIG. Method: Two-hundred and nine patients underwent liver transplantation (100 deceased donor liver transplantations [DDLT], 109 living donor liver transplantation [LDLT]) due to chronic hepatitis B infection between April 1997 and May 2005 in Ege University Medical School, Liver Transplantation Unit. Patients had prophylaxis with lamivudine and low-dose HBIG combination after liver transplantation. Treatment of recurrence consisted of AD 10 mg once a day and lamivudine 300 mg/daily and HBIG was discontinued in those patients. Results: In total there were 11 HBV recurrences: five occurred in DDLT recipients and six in LDLT recipients, at a median follow up of 18 months (range, 6-48 months). In one of 11 patients, pretransplant HBV-DNA and HBeAg were positive. Three patients had a severe course and one patient had fibrosing cholestatic hepatitis. After AD treatment, HBV-DNA level decreased in all patients and became negative in seven patients. Two patients died due to hepatocellular carcinoma recurrence after 12 and 14 months of follow up. Serum creatinine level increased mildly in one patient and no other side-effect was observed, and all patients continued therapy. Conclusion: Adefovir dipivoxil is a safe, effective treatment option for post-transplant HBV recurrence even among patients with fibrosing cholestatic hepatitis caused by lamivudine-resistant HBV

A new approach to the surgical treatment of parasitic cysts of the liver: Hepatectomy using the liver hanging maneuver

WOS: 000248382500014PubMed ID: 17657843AIM: To review 11 patients with parasitic cysts of the liver, who were treated by hepatic lobectomy using the liver hanging maneuver (LHM). METHODS: Between January 2003 and June 2006, we retrospectively analyzed patients who underwent surgical treatment due to parasitic cysts of the liver, at the Ege University School of Medicine, Department of General Surgery. Of these, the patients who underwent hepatic lobectomy using the LHM were reviewed and evaluated for surgical treatment outcome. RESULTS: Over a three-year period, there were 102 patients who underwent surgical treatment for parasitic cysts of the liver. Of these, 11 (10%) patients with parasitic cysts of the liver underwent hepatic lobectomy using the LHM. Presenting symptoms were abdominal pain, dyspepsia, and cholangitis. Cyst locations were as follows: right lobe filled with cyst, 7 (63%); segmental location, 2 (18%); and multiple locations, 2 patients (18%). All patients underwent hepatic lobectomy with an anterior approach using the LHM. The intraoperative blood transfusion requirement was one unit for 3 patients and two units for one patient. Postoperative complications included pulmonary atelectasy (2, 18%) and pleural effusion (2, 18%). No significant morbidity or mortality was observed. CONCLUSION: We concluded that hepatic lobectomy using the LHM should be considered, not only for hepatic tumors or donor hepatectomy, but also to treat parasitic cysts of the liver. (c) 2007 The WJG. All rights reserved